Printable QVCDC Training Registration Form
Print this form and mail, fax, or bring it in personally to:
Quaboag Valley Development Corp. (QVCDC), 23 West Main Street,Suite 1, Ware, MA 01082
FAX: (413) 967-3008
Registrant Information
Name: _____________________ Address: ________________ City: ___________ State: ____ Zip: _____
Day phone: ___________________ Evening Phone: ___________________ Email: ____________________
Course Information
Course Name 1: _____________________________ Start Date: ___________ Cost: ___________
Course Name 2: _____________________________ Start Date: ___________ Cost: ___________
Course Name 3: _____________________________ Start Date: ___________ Cost: ___________
Textbook 1: _____________________________________________________Cost: ___________
Textbook 2: _____________________________________________________Cost: ___________
Textbook 3: _____________________________________________________Cost: ___________
Subtotal: ___________
Discount Information
10% discount Senior Citizen Discount (computer
courses only)
____ Senior Citizen
Less 10% discount: ___________
TOTAL: ___________
Payment Information
Payment by: _____ Check _____ Visa _____ Mastercard
Card Number: _______ - _______ - _______ - _______ Expires: _____/______/_____
Name as it appears on card: _________________________ Card Billing Address: _____________________
_____ Income Eligible Fee Waiver (50% deposit required- contact the QVCDC for forms)
Miscellaneous Information
How did you hear of the QVCDC? ____________________________________________________________
Additional comments, questions or pertinent information, Special needs, etc.:
________________________________________________________________________________________
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