REGISTRATION

5 EASY WAYS TO REGISTER

PHONE: Call 330-896-8200

FAX: Send your registration and VISA or MasterCard information to 330-896-8297. Our FAX machine receives 24 hours per day, seven days a week.

MAIL: the registration form along with your payment to: Portage Lakes Career Center, 4401 Shriver Road, PO Box 248, Green, OH 44232-0248.

WALK IN: Bring your registration form with your check, cash, VISA or MasterCard

EMAIL: pl_conry@portagelakescareercenter.org

 AT THIS TIME, WE DO NOT OFFER ONLINE REGISTRATION.

PLEASE PRINT THIS PAGE, COMPLETE, AND RETURN.

Name______________________________________________      (   ) Male  (    )Female

Organization_________________________________________    Title_______________________

Address____________________________________________       Home          Business

City________________________________________________State_______Zip_______________

Home Phone_____________________Business Phone___________________________

Email___________________________________ Fax_____________________________________

Occupation_______________________________ Industry_________________________________

Course name/date/time______________________________________________________________

Additional Course name/date/time___________________________________________________

Additional Course name/date/time___________________________________________________

Payment Method

Please check one of the following:

(  ) Enclosed is a check payable to Portage Lakes Career Center

(  ) Please charge my VISA or MasterCard  *Note - we do not accept Discover

Name that appears on credit card:__________________________

Bankcard number:__________________________________

Expiration date:______________________________

How did you hear about us?

We will not be responsible for the confidentiality of any personal or credit card information transmitted via e-mail.