Planning Retirement Registration Form
 

Class Number: 66590
Location: 217 Coleman Center at Western Technical College
Dates: Wednesdays, March 28 - April 18, 2012.
Fee: $40.80  ($37.12 for those 62 and older)
Time:   6:30 - 8:30 p.m.
Registration     Deadline: Friday, March 16 by 4:30pm

                    

Please provide the following information to register for Planning Retirement. Required information is designated by an asterisk.

    Person ID number*            Telephone*

    Last name*                    First name*

    Address*

    City*                 State*                 Zip*

    Department*              Supervisor/Dept. Chair*   

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Have you attended this course in the past?*        Yes     No

Will your spouse or partner be attending the course with you?   Yes    No

( IF YES, READ THE DIRECTIONS FOR REGISTERING YOUR SPOUSE FOUND AT THE BOTTOM OF THIS PAGE.)

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The following information is voluntary. It is collected to enhance programming efforts at Western Technical College.

Sex    Marital Status    Ethnic Group

Birth date (month/day/year)*    County        Village/Township 

High school last attended         Highest grade completed

IF YOU AND YOUR SPOUSE WOULD LIKE TO ATTEND THIS COURSE (THE STATE WILL COVER YOUR SPOUSE'S REGISTRATION FOR ONE COURSE), PLEASE SUBMIT THIS FORM FOR YOURSELF, THEN HIT THE "BACK" ARROW ON YOUR BROWSER, COMPLETE THE REGISTRATION FOR YOUR SPOUSE, AND SUBMIT THE FORM AGAIN. BE CERTAIN YOU SUBMIT THE FORM FOR YOUR OWN REGISTRATION BY HITTING THE SUBMIT BUTTON BELOW BEFORE MAKING CHANGES TO THIS FORM AND REGISTERING A SPOUSE.