Online Registration Form - Cannon Valley Elder Collegium

Fall Term – 2025

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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 State ZIP Code

Optional: check if you want to notify us of any of these

This is my first CVEC class

Please do not share my phone number on the class list

Please do not share my email on the class list

If you wish to advise us that you have a hearing impairment

If you wish to advise us that you have a vision impairment

If you wish to advise us that you have an impairment- other

Course Registration

Courses:*

Optional Donation

Those who feel able are invited to include a tax-deductible contribution. Actual expenses incurred by CVEC per course registration average about $79. You can enter any amount below, which will be added to your total charged.

Total

Credit Card*

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