NON-CREDIT - New Jersey City University

NON-CREDIT COURSES
PLEASE PRINT CLEARLY
Course # Course Title Fee
Course # Course Title Fee
Name
FALL 2012
Date of Birth
Male q Female q
Ethnic Origin American Indian/Alaska Native Asian/
Pacific Islander African-American/Black (not of Hispanic
Origin) White (non-Hispanic) Hispanic Other
Home Address
City State Zip Code
q Please check if this is a new address
Telephone (Home) (Work) (Cell)
E-mail
Method of Payment: (NO CASH ACCEPTED)
q Enclosed is a check or money order in the amount
of $
payable to New Jersey City
University.
q Credit Card
q Discover q MasterCard q Visa
Card Holder’s Name
Card Holder's Address
City State Zip Code
Credit Card Number
Expiration Date Three-Digit Security Code #
Signature:
(Required)
Is this your first time registering for a course at New
Jersey City University? q Yes q No
Please return this form, with full payment, at least
ONE WEEK prior to the first class meeting to:
Office of Continuing Education
Hepburn Hall, Room 201
New Jersey City University
2039 Kennedy Boulevard
32
Jersey City, NJ 07305
http://web.njcu.edu/dept/continuing_ed Office of Continuing Education 201.200.3089 33›
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8/14/12 2:46 PM