***print this form and follow directions below**

Continuing Education Registration Form Semester:__________________________________

To pre-register, use this form. Besure to include your payment
for the full amount - DO NOT SEND CASH. Make checks payable to: CCSF-CSA. Mail to: Continuing
Education, Fort Mason Art Campus, Laguna & Marina Blvd - Bldg B, San Francisco, CA 94123
Fax: 415 561-1849 (Credit Card Registration) ___ Check here if you are a returning Continuing Education

Student Name______________________________________________

Soc. Sec. #__________________________ Email Address_______________________________________

Address___________________________________________________________

City_________________________________ State_______ Zip_______________

Phone# (H)__________________________ (W)___________________________

Class # / Class Title / Dates / Fee
__________PE 50 Fitness Center $90.00______________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

DO NOT include material fees with this enrollment TOTAL FEES____________

Credit Card Payment: Card #______________________________ Exp. Date_________

__VISA __MasterCard Signature________________________________________