Senior Computer Class Registration Form

Please either mail this form to:

PRUMC Sports and Recreation,  3180 Peachtree Road, Atlanta, GA, 30305

or drop it off at the Department of Sports, Recreation, and Life Enrichment

(located in the back of the Church, between the Preschool and the playground)

Please direct questions to: 404-240-8339

Participant Information:

Your Name: __________________________________________________________

PRUMC Church Member (circle one)?   Yes  /  No

*Date of Birth: ____ / ____ / _______     Gender (circle one):   Male  /  Female

Street Address: _______________________________________________________

City: ____________________________    Zip Code: ____________________

Home Phone Number: __________________________________

Email Address (if you have one): ___________________________________________

Class Preference Information:

Name of Computer Class: ________________________________________________________

Session Month and Year: ______________                Day/Time of Class: _______________

Computer Classes Previously Attended at PRUMC: ___________________________________

_______________________________________________________________________________

Method of Payment:

Credit Card # (Visa/MC only): _______________________________            Exp: ___/___        

or Check # (Pay to PRUMC): ______________   Amount: $25 (over age 50) or $50 (under age 50)

Please Print Name: __________________________________________

Signature: ________________________________            Date: ___________