Registration Form
Please print clearly

 Mr
 Ms

First Name,   MI,    Last Name
 

Street Number    Apt#

City

State

Zip Code

Company Name

Home Phone

Business Phone
Course Code
Start Date
Title
Fee












$ 
$ 
$ 
$ 
$ 
Payment: Total
$ 
Check (Make checks payable to University of Hawaii)
VISA MasterCard

Account Number

Exp Date
 
Signature
Date
PO

PO Number                 Company Name                   Address
I want to join the Emeritus Club ($25 annual donation, payable to UHF - Emeritus)

PARKING INFORMATION
(If you would like a parking pass,
please complete this section.)		 Call 845-9296 or complete the parking section of the registration form when registering. Unathorized cars will be ticketed.


Driver's License No.


State Issued

Make of Car/Year

Body Style

Color

Car License No.

State

Registered Owner

Address of Registered Owner

Liability Insurance Co.

HONOLULU COMMUNITY COLLEGE
Continuing Education & Training
874 Dillingham Boulevard
Honolulu, Hawai`i 96817-4598

FAX  808.845.3767
Phone 808.845.9296
E-mail cet@hcc.hawaii.edu