Revised 7/24/2013
Economic Development Programs
Registration Form
(Registration Deadline: One week prior to start of course)
Name: Sex: M F Date:
Address: County:
City: State: Zip:
Date of Birth: Race Code:
Grade Level Completed: Home Ph.:
Email:
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 penny@laniertech.edu, phone (770)531-4500 by 09:00 am the day before the course is to
be conducted. There will be no exceptions.
Name of Course: Date:
Location: Fee:
1.
2.
3.
4.
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. #
MC VISA Discover Card# V-Code: Exp. Date:
Card Holder (Please Print): Date:
Authorized By (Name/Title):
Signature only needed for invoice and credit card payments.
How To Register: MAIL - Lanier Technical College, Attn: Training Center, 2990 Landrum Education Dr.
Oakwood, GA 30566; FAX – (770)531-6355; EMAIL penny@laniertech.edu
1 –
Native
American
2 – Asian
3 – African
American
4 – Hispanic
5 – White
6 -
Multiracial
