Online Registration Form

Instructions: Fill in the blanks and make selections in the form to complete your course registration. Use the mouse or tab key to move the cursor to the next blank box. When you are done, press the Submit button at the bottom of the form to send your registration request to CCLS. You will receive a confirmation of your registration one week prior to class.

Course Title:

Course Date:

Registrant name:

Organization:

Mailing Address:

City: State: Zip:

Contact information:

Phone: Ext: Fax:

E-mail address:

Method of payment:

Check to be mailed in advance
Please bill institution

Direct institutional bill to the attention of:

Questions, comments, other notes:

If you wish to print a copy of your completed form for your records OR to send it in, print out this form BEFORE clicking on the Submit button. Send completed form to:

Central Colorado Library System
4350 Wadsworth Blvd., Suite 340
Wheat Ridge, CO
Fax:
Courier Code: CC-CCLS, Wheat Ridge

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Updated 02/02/02