Business Technology Education Department
Adult Class Registration Form
Name: _______________________________________ Telephone: ______________
Address: _____________________________________________________________
City/State/ZIP: _________________________________________________________
Race: ___ Black ___ White ___ American Indian ___ Spanish ___ Asian/Pacific Islander
Email Address _________________________________________________________
Do you have a computer at home? ___ Yes ___ No
Do you have Excel and/or Word on your home computer? ___ Yes ___ No
NOTE: Registration Fee of $50 must accompany this form on or before first night of class (September 19, 2006). Make checks payable to Pea Ridge Schools.