Class Registration Form

Name________________________________________________

Address________________________________________________

City __________________State_______ Zip__________________

Phone_______________________

Class Requested________________________________________

Date Requested (First Choice) _____________________________

(Second Choice)___________________________

*The American Red Cross reserves the right to cancel class 4

working days in advance if registration is fewer than 4 students,

students will be notified and given an opportunity to reschedule

or have their fees refunded.

*Participants class fees are transferable only one time

*Refunds are issued only if the Red Cross cancels class

*Class enrollment is taken on a first pay basis

*Participants must attend all sessions of the class

*Classes close to registration 48 hours prior to class date

*All registrations requesting billing to another party must be co-

signed by the appropriate supervisor

I understand the terms of agreement

——————————————————————————————————————–

Co-signer _________________________________________

Please Indicate Form of Payment: Cash_____ Check_________

Visa______ MasterCard______ Discover_________

Credit Card Number______________________________

Expiration Date: __________

Office Use Only: Date Received __________Receipt#____________

Amount Paid___________

320 North Buffalo Street Warsaw, In. 46580