I.D. No.__________
E-mail address ___________________________
Name __________________________________
Local Address:
______________________________________
______________________________________
_____Check
if new address
Phone No. _____________________________
____Check
if new #
|
Out-of-state address
________________________________________
________________________________________
_____Check
if new address
Out-of-state phone no:
________________________________________
_____Check if new # |
For office use only:
Received by__________________
Time:________
a.m.
p.m.
Date:_____________________
By:___________________________
fax
mail
walk-in
other
|
Check course page to verify fee, time and length of course.
Special Conferences and Lectures
____ SSYMP1 Rabil
____ SSCON 2 Morton
____ SSL1 Watson
____ SSL2 Evans
_________________________________
Performance Lectures
Fees: $15 single or 3 for $35
per member/$20 non-member
Tuesday:
____ SPL 61 Eli/Zeytoonian
____ SPL64E * Kofman and Students
Wednesday:
_____ SPL 71 Guastella
_____ SPL 72 Goldberger
Thursday:
_____ SPL 81 Neile
_____ SPL 82 Sanua
* evening course
_________________________________
Florida Atlantic University
LIFELONG LEARNING SOCIETY
777 Glades Rd. Box 3091
Boca Raton, FL 33431-0991
Phone: 561-297-3171
Fax: 561-297-3481
Web: www.fau.edu/lls
|
LECTURES
Mondays:
____S101 Stone 6
weeks
____S1011 3
weeks
____S1012 3
weeks
____S102 Albanese 6
weeks
____S1021 3
weeks
____S1022 3
weeks
____S103 B.
Atkins 6
weeks
____S1031 3
weeks
____S1032 3
weeks
__________________________________________
Tuesdays:
____S201 Rabil 6
weeks
____S2011 3
weeks
____S2012 3
weeks
____S202 Prier 6
weeks
____S2021 3
weeks
____S2022 3
weeks
____S203 DeRosa 6
weeks
____S2031 3
weeks
____S2032 3
weeks
__________________________________________
Wednesdays:
____S301 A& L
Series 6
weeks
____S302A Goldberger 4
weeks
____S303A Williams
~ 4
weeks
Kaufmann
__________________________________________
Thursdays:
____S401 Morton 6
weeks
____S402A Kula 4
weeks
____S403 Gould 6
weeks
____S4031 3
weeks
____S4032 3
weeks
__________________________________________
Fridays:
____S501 Nikoloutsos 6
weeks
____S5011 3
weeks
____S5012 3
weeks
____S502 McConnell 6
weeks
____S5021 3
weeks
____S5022 3
weeks
___S503 Kalish 6
weeks
____S5031 3
weeks
____S5032 3
weeks
|
REGISTRATION PAYMENT OPTIONS
Check: Make payable to FAU/LLS and mail it to the address on the cover.
Credit Card: Check type:
____Amex ____Discover ____Visa ____MC
Credit Card Number:
_____________________________
Date of Expiration: _________mm/yy
Security Code (Found on back of credit card, except for
Amex on the front) ______
Print name as it appears on credit
card:
______________________________
FEES - To Be Paid Per Student:
University parking, safety &
maintenance fee per student $ 14.00
Registration Totals $_______
Membership Dues $_______
Total Amount of check $_______
Total Amount to be charged $_______
I agree with the policies and
procedures noted herein.
_________________________________
Signature (mandatory)
---------------------------------------------------
Required for Parking Decal:
Car License # _____________
State of car registration:______ |