Name: Company:
(First) (Middle Initial) (Last)
Address: City: State: Zip:
Email: Phone: ( ) Secondary Phone: ( )
Where did you hear about this class?
Class Name/Description
Registration paid by check #:
Registration paid by cash, amount: $ _ Received By:
Refund/Withdrawal Policy
Occasionally, classes may be rescheduled, consolidated or canceled at the discretion of East Central College Business & Industry Center. In the event of a class cancelation by East Central
College Community Education, each student will be provided a full refund. To withdraw, students must contact East Central College Business & Industry Center no less than 48 hours prior to the start of
the class. Students that withdraw less than 48 hours prior to the start of class shall forfeit their right to a refund. Some programs may have specific policies which will be noted in individual class
descriptions. Locations, dates and times are subject to change, but participants will be notified. East Central College does not discriminate on the basis of race, color, religion, national origin, ancestry,
gender, sexual orientation, age, disability, genetic information or veteran status. Inquiries/concerns regarding civil rights compliance as it relates to student programs and services may be directed to
Heath Martin, Vice President of Student Development, 131 Buescher Hall, 1964 Prairie Dell Road, Union, MO 63084, (636) 584-6565 or
Revised May 14, 2019
Registration Date:
Registered By:
Invoice # Roster: _______
Payments Applied QBs/Roster________________
By Phone:
(636) 649-5800
Email to:
Mail to:
East Central College
Attn: CWD 1964 Prairie Dell Road
Union, MO 63084