Bucksport Adult & Community Education
Winter/Spring 2009 Registration Form

 * Name: _____________________________________________

  * Town of Residence: __________________________________
  * Address:    _________________________________________
                    _________________________________________
                    _________________________________________














  * Cell Phone: ________________________________________
  * Home Phone: _______________________________________
  * Work Phone:  _______________________________________
  * Date of Birth: _______________________________________



 
    Course Title                                                Course Fee (enclosed)
    ____________________________________  ___________________
    ____________________________________  ___________________
    ____________________________________  ___________________
    ____________________________________  ___________________


 
* Required Information

 
Please make checks payable to:  Bucksport Adult Education

 
Mail to:  Bucksport Adult & Community Education
              P.O. Box 1341
              Bucksport, ME  04416-1341