(Please print legibly)

Class Title: _______________________________________   Class Date:________________

Name: _____________________________________________________________________

La Plaza Member: __Yes __ No La Plaza username: ______________________________

Email Address: _______________________________________________________________

Mailing Address: ______________________________________________________________

City: _________________________________ State: ___________ Zip: _______________

Phone: (home) _________________________ (work:) _______________________________

Signature: ___________________________________________________________________

Registration Deadline is NOON the day before class. Cancellation Policy: Enrollee must give 48 hours notice if unable to attend or the fee will be forfeited. Registration form must be completed and the registration fee paid before adding a name to the roster. Four persons must be registered by the deadline or the class may be cancelled.

Attach check or money order to the registration form and mail to: Learning Center, 224 Cruz Alta, Suite F, Taos, NM 87571. For more information call Jovonna at 758-1836 or email training@laplaza.org.

There is $5.00 administrative fee for all Introductory Internet Classes (Intro to World Wide Web and Intro to WebMail). Fee refunded if La Plaza cancels class.

PAYMENT – Office Use Only Fee: $ ______________________ Payment Date: ___________________________ __ Cash __ Check #__________ Amount $ __________ __ Credit Card __ Visa __ MasterCard __ American Express Account No: _______________________________________ Exp. Date: ______________________________