EDUCATIONAL & RECREATIONAL

(ADULT EDUCATION)

CLASS REGISTRATION FORM

PLEASE PRINT

Name__________________________________________Day Phone________________

Address_______________________________________Evening Phone_______________

__________________________________________Zip__________e-mail____________

Course Title_____________________________________________________Fee____________

Session____________________________________________________Date____________

Municipality

 Carroll Township______     Dillsburg Borough_____     Franklin Township _____     Franklintown Borough_____     Monaghan Township_____

                                                Warrington Township_____     Wellsville Borough_____     Other_____

Make checks payable to NYCS Inc.

 Your cancelled check is your receipt.

Mail To: 

Northern York Community Services Inc.(NYCS)

P.O. Box 77

Dillsburg, PA  17019

In Person:

Registration at Dillsburg Borough Office, 151 S. Baltimore St., Dillsburg