UNITED
TECHNOLOGIES CENTER - CONTINUING EDUCATION -
Home
REGISTRATION FORM
Name: __________________________________________ Date:
__________________
Address:
_____________________________________________________________________
Town/City:
_______________________________
State: _____ Zip: ____________________
Home Tel: ___________________________
E-mail: _____________________________
Work Tel: ____________________________ Resident Town: _____________________
Are you a senior citizen? (62 or older: UTC
offers a $30 senior citizen discount on classes valued at $100 or more)
_____ Yes _____ No
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Name of Course
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Date
of 1st Course
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Cost
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Total
Enclosed:
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Please Make Checks Payable To: United Technologies Center
Mail completed form and payment to:
United
Technologies Center
200 Hogan Road
Bangor, ME 04401