LMU EXTENSION - Center for Religion &Spirituality

PARISH ADMINISTRATION PROGRAM
REGISTRATION FORM - FALL 2003

(Space is limited! Register today! Just print out this form, and mail it or FAX it in!)

RELX 920.01 - Parish Administration I          CRN: 50407          Term: Fall 2003

Full Name: ______________________________________________________________
                       Title           First                             Middle                Last                                           Suffix

Day Phone ( _____ ) __________________ Night Phone ( _____ ) __________________

Address ________________________________________________________________

_______________________________________________________________________

City ______________________ State _____ Zip ______________

Email Address __________________________________________

Social Security Number ________-_____-_________
(for registration purposes only)

Date of Birth ______ /_____ /________
(for registration purposes only)

Enclosed is my check for $ 600.00 (made payable to Loyola Marymount University)

Please charge $ 600.00 to my credit card:     Mastercard   Visa


Cardholder Name _____________________________________

Account Number ______________________________________

Expiration Date _____________

Authorizing Signature ___________________________________

Please mail completed form with payment to:

Center for Religion and Spirituality
Loyola Marymount University
One LMU Drive, Suite 1840
Los Angeles, CA 90045-2659

or FAX this form with credit card info to 310-338-2706