Registration Form

There are several convenient ways to register.  Begin by filling in your name, address and phone along with the classes for which you are registering.   Then:

	complete credit card information and click the "Submit" button below to have the information sent electronically to Creative Classrooms (transfer is sent over a secure server); or
	complete credit card information, print form, sign on the appropriate line and Fax to: 603 895-1326; or
	complete credit card information, print form, sign - or print the form without credit card information, include payment by check and mail to: Creative Classrooms, 81 Chester Road, Raymond, NH 03077; or

call Creative Classrooms and register over the phone 603 895-2437 (using a credit card or purchase order).

First Name:
Last Name:
Home Phone:
Business Phone:
Address 1:
Address 2 or E-Mail:
Town:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming
Zip
Grade Teaching:
SS: for credit option

I am registering for:

	$
	$
Graduate Credit Option $110.00 for NH residents and $125.00 for non-residents payable to Plymouth State University and a $25.00 admin. These fees are payable to Plymouth State University and can be paid the day of the first class.	$
Total:	$

Method of Payment:

Check:
$  Payable to Creative Classrooms, Inc.

Credit Card:
MasterCard   Visa   

Purchase Order: School or Company name: ____________________________________

Billing address ___________________________________

Town, State & Zip ___________________________________

PO # (Please forward hard copy of Purchase Order)

Acct. #    Exp. Date:  January February March April May June July August September October November December 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Name on Card:

[If mailing or faxing this form:]

Your signature: ________________________________________

Please note: If you register on line, you will receive a confirmation email within one week.  If you do not receive confirmation, please call to make sure your registration information was received.

Updated March, 2007