Factory Five Build School Registration Form

Directions for completing this form:
 Please print this form, fill it out and then return it to:
Livingston Center
Mott Community College
1240 Packard Dr.
Howell, Michigan 48843

You can also Fax this form to (517) 548-0784 or Register by phone at (517) 552-2163

Place an "X" in the box next to the session you are signing up for:
ROADSTER - $799  
Friday, Saturday and Sunday, 8:00 am - 5:00 pm  
Session No. Date
NOCR LVFFBS5-45 11/06-11/08/2009
NOCR LVFFBS5-46 12/04-12/06/2009
NOCR LVFFBS5-48 01/15-01/17/2010
NOCR LVFFBS5-49 02/26-02/28/2010
NOCR LVFFBS5-50 03/26-03/28/2010
NOCR LVFFBS5-51 04/23-04/25/2010
NOCR LVFFBS5-52 05/21-05/23/2010
NOCR LVFFBS5-53 06/25-06/27/2010
   
'33 Hot Rod - $799  
Friday, Saturday and Sunday, 8:00 am - 5:00 pm  
Session No. Date
NOCR LVFFBSH - 02 10/02-10/04/2009
NOCR LVFFBSH - 03 02/05-02/07/2010
NOCR LVFFBSH - 04 04/09-04/11/2010
   
= CLASS IS SOLD OUT  
All classes are held at Livingston Center - Howell, MI
(Deadline for registration is 10 days prior to the start date of workshop)

Name:  Birthdate:
Address:  City:  State:  Zip Code:
Home Phone:  Business Phone:
Email Address:
List any medical conditions:

Factory Five Build School Refund Policy
Absolutely no refunds, except when a section is cancelled. Students are permitted one reschedule date. Notice of intent to reschedule must be received in person (or in person by phone) no less than 30 days prior to the class date. Rescheduled classes must be made up before July 1. We will not cancel your seat or reschedule based on a voice mail or email message. I have read and accept the policy. I understand that my tuition is non-refundable.

Signature:
   
Your Registration cannot be processed if not signed above.

Payment Type:  Visa       MC       AmExp      Personal Check #
Name (as it appears on card):
Credit Card #:  Exp. Date:
Names of Attendees
Tuition $799 x No. of attendees:  = $
By signing below I agree with the terms of this registration. I understand that my credit card will be charged for the full amount of the tuition for each attendee I have named. I understand that the tuition will not be refunded for any reason, except when a class is cancelled. Your registration cannot be processed without your signature.

Signature of cardholder: