M.C.C.Form Print, fill out and mail to NORTH CAROLINA CUSTOM KNIFEMAKERS GUILD SCHOOL AND MONTGOMERY COMMUNITY COLLEGE REGISTRATION FORM Phone: 910-576-6222 Fax: 910-576-2176 Mail completed registration forms and fees to: NC Custom Knifemakers Guild School Attention: Continuing Education Montgomery Community College 1011 Page Street Troy, NC 27371 (No space will be held without advance payment) (Please print or type) Name: (last)_______________________ (first) ____________________ (middle) _________ Mailing Address: _______________________________________________ City:____________________ State: _______ Zip: ___________ County:__________________ SSN: __________________________ Date of Birth: __________________________ Home Phone: __________________________ Work Phone: __________________________ Sex: Male Female Race: White Black Indian Hispanic Asian Education: (Check highest level completed): 1 2 3 4 5 6 7 8 9 10 11 GED Adult High School Post High School Voc. Diploma Associate Degree Bachelor Degree Master Degree or higher Employment (Please check one): Full-Time Part-Time Unemployed Retired Method of Payment (Please check one): Check or money order enclosed (Payable to Montgomery Community College) Please charge my credit card: Master Card Visa Account Number: - - - Expiration Date: _________________________________ Print Name on Card: _________________________________________________ Authorized Signature: __________________________ Date: ______________________________ Registration fees are nonrefundable. Materials will be provided for classroom use for all hands-on courses. Check in the right column all courses you plan to attend: Date: Type: Total Cost: Check Here: Custom Folding Knives May 20-23, 2004 Hands-on $315 Grinding Knife Blades June 18-20, 2004 Hands-on $240 Metal Engraving July 2-11, 2004 Hands-on $100 Automatic Folders August 5-8, 2004 Hands-on $315 Basic Knife Making August 19-22, 2004 Hands-on $315 Forged Blades September 16-19, 2004 Hands-on $315 Powder Damascus Steel October 15-17, 2004 Hands-on $240 TOTAL AMOUNT ENCLOSED Mail completed registration forms and fees to: NC Custom Knifemakers Guild School Attention: Continuing Education Montgomery Community College 1011 Page Street Troy, NC 27371