SFAGC Online Class Registration Form

South Florida Chapter AGC
On-Line Registration Form

You must include your e-mail account and telephone number!

If you wish to pay for the class with a credit card, we will call you back to get that information. Filling out this form does not register you for class! Payment must be received prior to actually being registered for class.

Term: Year:

Your Name:

Address where textbook will be sent -
Number & Street:
City: State:
Zip Code:

Telephone Numbers (with area code):
Daytime: Evenings:
You must include your telephone number(s).

Email Address: (You must include your email address)

Sex: Male Female

List online courses for which you are registering:

Course #1 Title:

Course #2 Title:

Course #3 Title:

Course #4 Title:

Course #5 Title:

Payment Method:
Will send check (must be received by SFAGC within 5 days)
Charging to credit card (we will call you for your card number or call us at (954) 693-9322
Other

Do you have any questions or other comments?

If sending a check, please make it out to South Florida Chapter AGC. Write the course(s) for which you are registering on the check. Send your check to the following address.

South Florida Chapter AGC
Att: Len Mills
1395 Shotgun Road
Sunrise, FL 33326
(954) 693-9322
Fax (954) 382-5748