Exploring Our Humanity Conference Registration Form

Fill out this page, print it (choose File/Print in your browser) then mail or fax to:

Extended Education Registration
Sonoma State University
1801 E. Cotati Ave.
Rohnert Park, CA 94928
FAX: (707) 664 2613

Social Security #
(last 4 digits)
Birth Date
Sex
Last Name
First Name
Address
City
State
Zip
Phone
Fax
Email
Job Title
School/Agency
School Address
Grades taught
Subjects taught
Degree Held
Ethnic Code
Enrolled at SSU before?
Check the version of "Exploring OUr Common Humanity" you wish to take (credit or non-credit)
 
Department
Credit/Non-Credit
Class # (0000)
Fee

SOCI 497		 1 unit 1212 $55
SOCI NC Non-credit 1213 none
Registration Fee $
Total Fees:
Method of payment

Name on Card
(Signature, if mailing)
VISA/MasterCard
Expiration Date

Fill out this page, print it (choose File/Print in your browser) then mail or fax to:

Extended Education Registration
Sonoma State University
1801 E. Cotati Ave.
Rohnert Park, CA 94928
FAX: (707) 664 2613