Flyer 06 Registration

City & State *

Phone Number *

Gender *

Male

Female

Registration

Are you a New Student at ICD? *

Yes

No

Hire Date *

Zip Code *

Name - First, Last *

Clock Card Number *

Email Address *

Union Status *

Active Union Member

Retiree

Diversified

Birthday *

If registering for two classes, please complete two registration forms and select first or second choice.

First Choice Class

Second Choice Class

Form Submission *

When you click Submit, your registration form is sent to ICD. You will receive an email confirming your enrollment the week prior to the start of the class. Thank You!

Mailing Address - Home or P.O. Box *

Department Number *

SMALL ENGINE REPAIR & OPEN SHOP *

A&C

B&D

Apartment - If No Apt-put NA *