CIMC Course Registration Form



Name ___________________________________________________________________

Address _________________________________________________________________

City ____________________________________ State _________ ZIP _____________

Home phone ( ___ ) ____________ Daytime phone (____) _______________ Email: ______________________________

Are you a member? [  ] Yes [  ] No

[ ] Check here if you would like to receive membership information by mail.

The printed brochure, including the schedule and a membership form is available when you visit the center.
[ ] Please check here, however, if you would still like a brochure mailed to you.

[ ] I prefer to use the online schedule. No need to send a brochure.



COURSE CODE COURSE DESCRIPTION FEE
__________ ________________________________________________ $__________
__________ ________________________________________________ $__________
__________ ________________________________________________ $__________
Total Enclosed: $__________


  • Please mail payment-in-full to: CIMC, 331 Broadway, Cambridge, MA 02139.
  • No confirmation notice will be sent. We will contact you if a program is full.
  • If you have questions, please call (617) 441-9038.