41 Morrill Avenue, Room 192
January - May 2008
Gorham, Maine 04038
222-1095
Name: ____________________________________________________________________
Address: __________________________________________________________________
City: ________________________________ State: ___________________ Zip: ________
E-mail address: _____________________________________________________________
Phone (H): ______________________
Pnone (W): _____________________
To help us plan classes, please provide your year of birth: _________
Please enroll me in the following courses:
1. __________________________________________ Cost: ________________
2. __________________________________________ Cost: ________________
3. __________________________________________ Cost: ________________
4. __________________________________________ Cost: ________________
Office Use Only
CK # ______________________ Cash: ___________________
Credit Card: ____________ Date: ___________
Paying by Credit Card?
Card # _____________________________________
Expiration Date: ________________________________
Signature required: _______________________________
Mailing a Check or Money Order?
Make check payable to Gorham Adult Education. Mail to
Gorhan Adult Education
41 Morrill Avenue, Room 192
Gorham, Maine 04038
Upon receipt of registration and payment, you are enrolled. You
may call 222-1095 to check on your course status, or we will e-mail you
a confirmation if you provide your e-mail address and request
confirmation.