Registration Form
Stetson University Center
800 Celebration Avenue
Celebration, FL 34747

Student Information:

_________________________________________________________________
Name
_________________________________________________________________
Address
_________________________________________________________________
City                 State             Zip Code         E-Mail Address
_________________________________________________________________
Social Security Number                 Day Phone
_________________________________________________________________
Business/Organization

_________________________________________________________________
Please enter your Priority Code (such as STP024) if you have one

__________________________________
Student's Signature

  _______________
Date

Accepted By:
__________________________________
School Official

  ________________
Date

Register for Communication Effectiveness using any of the following options:
  Phone: (321) 939-7616       Fax: (321) 939-7606
  Mail:
      Registrar, Stetson Center at Celebration
      800 Celebration Avenue, Celebration, Florida 34747


Communication Effectiveness

Date:       January 17, 2006     8:30 a.m. to 5:00 p.m.     Lunch included.
Tuition:   $159 (1 person); $149 ea. (2-5 people); $139 ea. (6+ people)

Method of Payment:
  [  ] American Express     [  ] MasterCard     [  ] VISA     [  ] Diners Club
  [  ] Check or Money Order (Made to Stetson University)
    (for Credit Cards:)
      [  ]  Card Number: ____ ____ ____ ____
      [  ]  Exp. Date: ____________________
      [  ]  Signature: _____________________

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