Spring 2007 REGISTRATION FORM
 

Complete this form and click "Submit" below to register online, OR

Make a copy of the completed form with a check payable to "St. Bernard's" or credit card information and mail to:  St. Bernard's, 120  French Road, Rochester, NY 14618  Attn: Ellen Morningstar, Registrar    OR

Register in person by bringing a copy of the completed form to the Registrar's Office  along with check or credit card.

Last Name      
First Name:    Middle:
Address 1:     Apt: 
Address 2:     Apt: 
           City:       State:    Zip:
Home Phone:    Work Phone:   Ext:
E-mail:          
Category:      
        Certificate Candidate          Certificate Area:
                Personal Enrichment (non-certificate) :     Audit  Credit

Please check appropriate box(es):         

Billing Instructions:                               

      
Select American Express Discover Master Visa
Acct #    Exp. Date:  Mo 01 02 03 04 05 06 07 08 09 10 11 12   Yr 03 04 05 06 07 08 09 10 11 12  
(even if no payment is being made, please enter choices for month and year)
Name on Card:
 
Bill parish
Parish:  Parish Address:
    City:                 State:      Zip: