Fillable STA Form (Cerritos College)

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STA Form (Cerritos College)

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Course Registration
Cerritos College
11110 Alondra Blvd.
Norwalk, CA 90650
Phone: 562-860-2451
Ext. 2912
www.cerritos.edu/auto
Seminar : Stepping Thru Parking & Passenger Drop Offs
Course Dates:
Main Contact:
Attendee Information
Name:
Name (2):
Name (3):
Name (4):
Company:
Address:
State/Province:
Zip/Postal Code:
Country:
Email:
Phone:
Special Needs:
Registration Fees
Course Fee: $125 or $95
x Number of Attendees:
Subtotal:
Total Due:
Payment
City:
Payment due to Cerritos College by:
9/7/10
Check
Make payable to:
Jannet Malig - Automotive Technology
Cerritos College
11110 Alondra Blvd.
Norwalk, CA 90650
Credit Card
Visa
Mastercard
Card Holder's Name
Expiration Date
Card #
After payment is received confirmation
will be sent through email
$95 early registration by 9/15/2010
$125 after 9/15/2010
October 15, 2010, 9:00am - 12:30pm
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STA Form (Cerritos College)

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Completed 21 July 2020

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