TEXARKANA COLLEGE/BILL MORAN
SCHOOL OF BLADESMITHING
Registration Form
Print this form
To Register By mail - Make check payable to: Texarkana College
and send with this form to:
Texarkana College
Community Services
2500 N. Robinson Road
Texarkana, Texas 75599
Tuition must accompany application to ensure enrollment
Name: Last _________________ First ___________________ M.I.______________
Social Security No. ______________________Date of Birth ___________________
Address ___________________________________________________
City ________________________State _______________Zip ______________
Social Security No. ______________________Date of Birth ___________________
Address ___________________________________________________
City ________________________State _______________Zip ______________
Email____________________________________________
Day Phone ____________________ Evening Phone _____________________
Course Title _____________________________________________________
Starting Date _______________Time ___________Tuition $ _____________
The following information is required by the Coordinating Board
of the Texas College and University System.
Male ____ Female ____
White ___ Black ___ American Indian ___ Asian ___ Hispanic ___ Other___
Day Phone ____________________ Evening Phone _____________________
Course Title _____________________________________________________
Starting Date _______________Time ___________Tuition $ _____________
The following information is required by the Coordinating Board
of the Texas College and University System.
Male ____ Female ____
White ___ Black ___ American Indian ___ Asian ___ Hispanic ___ Other___
It is the policy of Texarkana College not to discriminate on the basis of sex, disability, race, color, age or national origin in its educational and vocational programs, activities or employment as required by Title IX section 504 and Title VI
TEXARKANA COLLEGE
Community Services Division
Texarkana, Texasin cooperation with: The American Bladesmith Society, Inc.
and
The Pioneer Washington Restoration Foundation
Contact Regina Fant at 903 838 4541 ext 337 or rfant@texarkanacollege.edu
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