Online Registration

To register for Basics 101 - November 2 at DMACC Ankeny Bldg 18 - Rm 35 on Tuesday, November 02, 2010, please fill out the information below. Please Note: Only one person per registration is allowed.  * Information required for registration and CEU tracking. *Name:      *Social Security: -- Representing:      Home Phone: ()-     *Ethnic Origin: Alaskan Native American Indian Asian Black/African-American Caucasian Hispanic/Latino Puerto Rican Other *Home Address:      Sex:  Male Female      DOB: *City:      State:      *Zip:      Email: Are you a County Sanitarian (EHS)? No Yes      If so, which county/ies? Type of Credit Card: -- Select -- Visa MasterCard Discover    Credit Card Number:       Expiration: MM 01 02 03 04 05 06 07 08 09 10 11 12  / YYYY 2010 2011 2012 2013 2014 2015 For more information, contact Annette Adams at (515) 964-6464 (phone), (800) 362-2127, option 5, ex. 6464, (515) 964-6604 (fax) or aladams@dmacc.edu Refund Policy: To drop or withdraw your registration and receive a full refund, you must notify Registration at least 48 hours (two business days) before the start of class. If OWTC of Iowa cancels the class, you will receive an automatic refund. Please allow 3 weeks to receive the refund.