Attendee(s)

Payment

Receipt

* Indicates Entry is Required

		Thursdays, Aug. 15 & 22 6:00 p.m. to 9:00 p.m. Printed Workbook		123 Main Street Nowhere, AK 99276 Map
		Additional Class Information: These are example comments for this 1st class - legacy style class.

		Tuesdays, Aug. 20 & 27 6:00 p.m. to 9:00 p.m. Digital Workbook		This Class Is Online Only - Local Instructor
		Additional Class Information: Please register for this class using this link: https://go.uwplatt.edu/retirement-dubuque

		Saturdays, Aug. 24 & 31 6:00 p.m. to 9:00 p.m. Digital Workbook		123 Main Street Nowhere, AK 99276 Map Online Option Available - Local Instructor

Total Course Fee: $0.00

First Name*

Middle (optional)

Last Name*

One person's name only — Spouse/Partner/Guest is added below.

Mobile Phone*

Daytime Phone

Evening Phone

Email*

Address 1*

Address 2

City*

State*

Zip Code*

If you are unsure, please keep in mind that space is limited.One workbook provided with registration.

Spouse (+$20.00)
Guest (+$20.00)
Partner (+$20.00)
Nobody, just me

Additional Attendee's Name

Add an extra workbook (+$30.00)

Total Course Fee: $0.00