Community Bridge October 2020 - January 2021

Independent School District 622 2520 E 12th Ave North St. Paul, MN 55109 NON-PROFIT ORG U.S. POSTAGE PAID TWIN CITIES MN PERMIT NO. 4263 Gladstone Community Education Center Community Bridge Consortium office 1945 Manton St. Maplewood, MN 55109 651.748.7250 COMMUNITY BRIDGE REGISTRATION FORM Name_______________________________ Day Phone__________________ Evening Phone__________________ Address___________________________________________________ City___________________ Zip___________ Group Home Name_______________________ Contact Person____________________ Phone__________________ Email (required)________________________________________________________________________________ Class # Class Name Class Fee _____________ ________________________________________________________________ $____________ _____________ ________________________________________________________________ $____________ _____________ ________________________________________________________________ $____________ _____________ ________________________________________________________________ $____________ Checks payable to Community Bridge. Mail to: Community Bridge, 1945 Manton St, Maplewood, MN 55109 Total Fee $____________ or Visa, MasterCard or Discover ________ ________ ________ ________ Exp___/___ Total Charge $_________ Signature ___________________________________ Name on Card_______________________________________ (Print) Due to the unpredictability of COVID-19 we are using a “Register Now Pay Later” procedure. Your credit/debit card or checking account will be charged 3 days prior to the class start date. If you are mailing your registration into the office along with a check, your check will be handled as a one-time electronic fund transfer or draft. You will be notified if classes are cancelled.

Community Bridge October 2020 - January 2021 | Page 4