Form Center

2. 1. Name (First and Last) *
4. 2. Phone Number *
6. 3. Email address
8. 4. Street Address*
10. City, State, Zip *
12. 5. Do you currently have a library card? *

    1. Yes
    2. No
14. 6. If not, would you be interested in finding out how to get a library card.

    1. yes
    2. no
16. 7. Which class are you signing up for? *

    1. Basic Internet Instruction- Tuesdays at 2:00 p.m.
    2. Basic Computer Introduction for Seniors- Wednesdays at 10:30 a.m.
    3. Job Seeking and Careers- Saturdays at 10:30 a.m.
    4. Introduction to Language Learning Software for Children and Teens- Fourth Thursday at 5:00 p.m.
18. 8. Spaces in our classes are limited. If we are not able to get you into our next class, what are some other dates you are available? *
20. 9. Please tell us a little bit about what you are hoping to learn how to do.
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field