EVENING SCHOOL REGISTRATION FORM

  1. Fill out this form on-line include your credit card information
  2. Print out the form for your records
  3. Fill out this form online
  4. Mail or fax the form to the address or FAX number on the bottom of the form
  5. Include check or money order

NOTE: We will not process registration requests submitted until payment is received.

First Name:  Middle Initial:   Last Name:

Street Address:
City, State, Zip:
Phone Day:
Phone Eve.:
Cell:
Email:
Emergency Contact:
Emergency Phone:
First Class:
Tuition:
Second Class:
Tuition:
Registration Fee: $5.00
Total Due:
Date:

Paymnet Type: VISA MasterCard Check Money Order

Credit Card Number:
Expiration:
Signature:

CHECKS PAYABLE TO:

SOUTHEASTERN REGIONAL SCHOOL DISTRICT (SERSD)
SOUTHEASTERN TECHNICAL INSTITUTE - 250 FOUNDRY STREET, SOUTH EASTON, MASSACHUSETTS 02375 - PHONE: 508.238-1860 - FAX: 508.230.1558
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