Online registration form – Fall 2021 "*" indicates required fields This online registration form can be used for individual students who are not seeking financial assistance. If you wish to register as a couple or request financial assistance, please complete the paper form.Student Name* First Last Student Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Optional: check if either of these applies This is my first CVEC class Please do not share my address, phone number, or email on the class list Course RegistrationCourses:* Optional DonationThose who feel able are invited to include a tax-deductible contribution. Actual expenses incurred by CVEC per course registration average about $83. You can enter any amount below, which will be added to your total charged. Total Credit Card*Card Details Cardholder Name CAPTCHAHiddenOptionFirst OptionCommentsThis field is for validation purposes and should be left unchanged.
