| Emeritus College |
Emeritus College
Enrollment Form
Emeritus College Registration
Mail to: Emeritus College of DVC
1250 Arroyo Way
Walnut
Creek, CA 94596
or Phone: (925)
906-9106, or Fax: (925) 906-9103
Name___________________________________________
Address___________________________________________
City ________________________Zip_______________
Daytime Phone____________________________________
| Class Title | Fee | Only DVC* Parking | Total |
| Annual Membership $40 | |||
| Lifetime Membership (Tax Deductible) Individuals $150, Couple $200 |
|||
| Emeritus Scholar $1,000 |
_____Check enclosed ** made payable to Emeritus College, DVC.
_____ Visa or Mastercard #_______________________________________
Expiration Date_________________
Signature_______________________________________________________
NO REFUNDS GIVEN UNLESS CLASS IS CANCELLED BY
EMERITUS COLLEGE
