CLOVIS COMMUNITY COLLEGE
Non-Credit Class Registration Form
Name (Last, First, Middle) Parents name (for Kids College)
Mailing Address/Street or P.O. Box City/State Zip
Best Phone (Cell/Work/Home)
Alternative Phone (Cell/Work/Home)
Email Address
Note: If an e-mail address is listed please expect a registration confirmation within 2 business days
Course Title
Fee
Course Title
Fee
Course Title Fee
Total
Please indicate if your employer or business is paying for this course.
Name: Mailing Address: ____________________________________________
Please charge to my: Mastercard
Visa Discover
American Express
Card Number
Expiration Date
Signature Date
For Official Use Only
Al Potthoff
Clovis Community College Business &
Non-Credit Training 417 Schepps Blvd,
Clovis, NM 88101 Phone: (575) 769-4760
Fax: (575) 769-4190
http://www.clovis.edu/noncredit
COMSER
KIDCOL
CONTR
Exact
Name As It Appears on the Credit Card
CVV #
Date:
Invoice:
Cashier:
Course Title
Fee
$ 0
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