ADULT EDUCATION REGISTRATION FORM – 2008

Course Title________________________ Day/Time__________________________

__________________________________ _________________________________

__________________________________ _________________________________

Payment Method: Cash________     Check________   Credit Card________   

Total __________ 

Credit Card #________________________________

Expiration Date__________________________

Name________________________________________________________________

Address______________________________________________________________

Phone __________________________ E-Mail_______________________________

Please return to:

Temple Beth Haverim

29900 Ladyface Court

Agoura Hills, CA 91301