Economic Development Division
(Registration Deadline: One week prior to start of course)
Name: Sex: M F Date: ______________
Address: County: ______________________________
City: State: Zip: ________________
Date of Birth: / /
Grade Level Completed: Home Ph.: _________________________
Employer: Fax: _________________________
Business Ph.: Other: ________________________
Employer Address: _____________________________________
City: State: Zip: ________
CANCELLATION POLICY: You may cancel your reservations or reschedule up to one day prior to the course without
penalty. Due to the limited notice, all cancellations received less than one day in advance will NOT be refunded. To
cancel a course please e-mail firstname.lastname@example.org, phone 770.533.6992 by 09:00 am the day before the course is to
be conducted. There will be no exceptions.
Name of Course: Date:
Minimum Class Size Policy: We always strive to conduct all scheduled courses. However, there may be times when
registration numbers will require us to reschedule. We apologize for any inconvenience!
Method of Payment
(Please check one)
Check # Cash Invoice – must provide P.O. #
If paying by Debit/Credit Card please call 770.533.6992 or 770.533.6993
How to Register: MAIL - Lanier Technical College, Attn: Building 500, 2990 Landrum Education Dr.
Oakwood, GA 30566; FAX – (770)531-6355; EMAIL email@example.com