ONLINE REGISTRATION FORM

MAIL-IN OR FAX REGISTRATION FORM

Complete this registration form and:

Mail To
Eastern Iowa Community College District
Attn: Registration
306 West River Drive
Davenport, IA 52801

OR

Fax To
Clinton Community College - (563) 244-7053
Muscatine Community College - (563) 288-6116
Scott Community College - (563) 441-4053

Send a check or money order (no cash please) with the class number(s) and student's social security number written on the lower left hand corner. We will call you to confirm faxed registrations.

Tuition and fees are due at time of registration. Refunds will be issued if you cancel your registration seven days prior to the start of a class.

Name:
_________________________________________
Company Name or Vendor number:  
_________________________________________
Address:
_________________________________________
City/State/Zip:
_________________________________________
Day Phone:  _______________________________
Night Phone:  ______________________________
Social Security No.  _________________________
Prof. License No. (if applicable): ________________
E-mail Address:
_________________________________________
Class Title: ________________________________
     Class No.  ___________ Tuition/Fee: $________
Class Title: ________________________________
     Class No.  ___________ Tuition/Fee: $________
Class Title: ________________________________
     Class No.  ___________ Tuition/Fee: $________
Total: $ ________

Make checks payable to "Eastern Iowa Community College District" or use your Credit Card.

Please charge all fees to (check one):
Mastercard____ VISA____
American Express____ Discover____
Credit Card No. ____________________________
Name on credit card (please print):
_________________________________________
Expiration Date: __________
Signature: _________________________________
Date:  ____________________________________

I have read and understand the registration and refund procedures for Continuing Education.
Signature: _________________________________
Date:  ____________________________________

FOR YOUR INFORMATION
Every effort has been made to make this publication accurate as of the date of issue; however, all policies, procedures, tuition fees, and curriculum are subject to change any time by appropriate action of the faculty, the college administration or Eastern Iowa Community College District Board of Directors. This publication is not intended to be a contract, explicit or implied, and the college reserves the right to make changes in information contained herein.

Attendance - You must attend the complete offering and meet the program objectives to be eligible for contact hours or continuing education units/hours.

Refunds and Substitutions - If your plans change, you may cancel your registration up to seven calendar days prior to the start of the program. After that, no refunds will be issued. You may however, apply the tuition toward another class that meets your scheduling requirements or you may choose a gift certificate in the amount of your class to use within one year of the date issued. Please note that if you don?t cancel and don?t attend, you are still responsible for payment.

Class Cancellation - Seven days prior to the activity, a decision will be made by the college administration to run or cancel the program based on the number of individuals who have enrolled and paid.Each college reserves the right to cancel a class due to insufficient enrollment.

Postponing Classes Due to Bad Weather - In bad weather,classes may be postponed. This does not occur very often. Listen to local radio stations for college announcements.

Grievance Policy - If you have a problem or concern with any offering, please contact the Continuing Education Office at the college district.

Scott Community College Urban Centerand Kahl Education Center PARKING DIRECTIONS - Free parking is available in the last row of the parking lot behind the Freight House (southwest corner of Ripley and River Drive). Just write your course number on a sheet of paper and leave it on your driver?s side dashboard. Please park ONLY in the last row marked SCC Parking. Metered parking is also available on Ripley and Second Streets (25 cents for 50 minutes) and in the parking ramp at W. Second and Ripley (75 cents per hour). All downtown parking is free after 5 p.m. and on weekends.