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Fax Registration Form
Print out and complete this form. Fax with credit card information to
Community Education at (360) 752-6770. You may also mail the form with check attached to:
Whatcom Business Office, 237 W. Kellogg Road, Bellingham, WA 98226.
Whatcom Community
Education Fax Registration Form |
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Name: |
(Optional)
Student ID#: |
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Soc Sec #* |
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*To
comply with federal law, we are required to ask for your Social
Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
We will use your SSN/ITIN to report Hope Scholarship/Lifetime tax
credit, to administer state/federal financial aid, to verify
enrollment, degree and academic transcript records, and to conduct
institutional research. If you do not submit your SSN/ITIN, you
will not be denied access to the college. Pursuant to state law (RCW
28B.1.042) and federal law (Family Educational Rights and Privacy
Act), the college will protect your SSN from unauthorized use and/or
disclosure. |
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Have you
ever attended Whatcom? ___ |
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Address: |
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City /
State / Zip: |
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Day Phone: |
Date of Birth: |
Male / Female |
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Evening Phone: |
Email Address: |
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Class # |
Class Title |
Time |
Start Date |
Fee |
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Total Payment Enclosed: |
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| Payment method: |
[ ] Check Payable to Whatcom Community College
[ ] VISA [ ] MasterCard (VISA & MC also accepted by phone:
647-3277) |
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Account
Number: |
V#: |
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Name on
Card: |
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Expiration: |
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