Center For Human Development

COURSE REGISTRATION FORM — FALL 2010

* USE THIS FORM ONLY FOR REGISTERING.
To attend classes you must register officially. (Please do not contact instructors, unless so directed in the course description.)

NAME                                                                                                                                               

ADDRESS                                                                                                                            

CITY                                                                           STATE            ZIP CODE                 

PHONE                                                                      E-MAIL                                                         

How did you hear about us?                                                                                                                  

_______________________________________________________________________________

 

• You may register for courses as soon as you receive this form. Registrations received after 9/3/10 must be accompanied by a $25 late fee.

• Make checks payable to CHD and mail to 16-21 Split Rock Rd., Fair Lawn, NJ 07410