¨Adult Services ¨ Early Childhood Initiatives ¨Organizational Support Services   
      ¨Student Services     ¨Teaching & Learning       ¨Technology Solutions

HOME     DIRECTORY   LINKS   SEARCH


REGISTRATION  FORM
Adult & Community Education

Mail-In Registration Encouraged! Registration Form in PDF.
 You may complete the online registration form below, print it out, and mail it to the office nearest you. Please make your check payable to: Community Ed/EASTCONN and mail to:
Northeast Learning Center, 111 Connecticut Mills Ave. Danielson, CT 06239

  Please complete:

Name

E-Mail Address

Home Address

Home City

Home State

Home Zip Code

Home Telephone

Work/Cell Telephone

Course Requested:

Course Location:

Course Date:

Course Time:

Select your Payment Method
Type of Purchase

Credit Card Number

Expiration Date:

Name as it Appears on Card
V code (3 digit code on back)
Comments, Questions, or Special Needs

   

By Phone or Fax with VISA or Master Card only:
Danielson-Putnam (860) 779-3770; FAX - (860) 779-3384