Centro Cultural - Class Registration

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Registration:

(*) Required
What class would you like to sign up for?:
*Name:
*Last Name:
*DOB:	MM/DD/YYYY ex: "01/01/1990"
*Address 1:
Address 2:	ex: "PO Box; Apt #, Unit #, Suite #"
City:
State:
*Zip Code:
*Phone Number:	ex: "1234567890"
e-mail:	ex: "you@yoursite.com"
Do you need Child Care:	Yes No
How did you hear about our classes?
What country are you from?
Note: Upon submitting your registration you wil be re-directed to PAY-PAL to finalize your registration and payment. *If you do not have a credit card available, please contact us so we can set-up another method of payment.

1174/1110 N Adair St | Cornelius, OR 97113 | Phone: (503) 359-0446 | Fax: (503) 357-0183 | E-mail: centroinfo@centrocultural.org