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Workforce or Business and Professional Development

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Personal Information

Name:

E-mail:

Address:
Street/P.O. Box:

City:

State:

Zip:

Age*:

Sex*:  Female   Male

Birth date:

Home Phone:

Work Phone:

Social Security #:

1.  How many years have you lived at the above address?
2.  If a Wyoming resident, how many years have you lived in Wyoming?

Do you give WWCC permission to release your name, address, and enrollment status as part of our directory information? Yes No

Ethnicity:                  

*Required for reporting purposes only.

Course Date Course Number Course Title Fee

I am enrolling in this course/activity for the following reasons:

If Other:

How did you find out about this class?
(FOCUS booklet, flyer, TV, WWCC class schedule, e-mail, web, word of mouth)

Payment Method
 

Cash/Check

 

Credit Card , Please call (307) 872-1326 with your card information

 

Purchase Order # Company 

 

Bill Company Mailing Address

Individuals are personally responsible for payment in the event that the indicated company or organization fails to make payment in full.

I understand that once my registration is processed, I am officially registered for the class and am responsible for all debts incurred.  If my account is not paid in full, I understand that the College may hire a collection agency to take action.  If my account is assigned to a collection agency, I understand that I am responsible for all attorney fees, court costs or delinquency fees that may be incurred during the collection of my debt.  I understand that the delinquency fee will be equal to 50% of the principal amount owed.  If a refund is due from my account, I authorize the College to automatically issue a refund check.

I have read the statement above:                  

 
 

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  Call us early with your ADA needs.  307.382.1806

  If you have any questions please feel free to contact us at: 307.872.1326

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