Wellesley College Summer School 2005

On-Line Pre-Registration Form
for Non-Wellesley College Students

In order to register for courses, please submit this form. Within 48 business hours you will receive an email containing a PIN number and college ID number, as well as instructions on how to register on-line for your courses. If you require parking, please fill out a Parking Request form, found on the General Information page, under Transportation & Parking.

* indicates required fields

Social Security #

Last Name*    First Name*   Middle Initial

Current E-Mail Address*
Confirm Current E-Mail
*

Current Mailing Address
Stree
*t   City*   State*   Zip Code*

Phone Number*

Gender  Male Female

Date of Birth

College / University  or High School

Courses you are planning to register for:

Course #   Course Title

Course #   Course Title

How Did you hear about the Wellesley College Summer School?

Friend Newspaper Advertisement Mailing Web Search Other

If you have any questions, please contact Katherine Rooks at krooks@wellesley.edu or 781-283-2200.

Thank you for choosing Wellesley College!

Submitting this form does not register you for classes.
You are not registered for classes or responsible for any payment until
you register on line with your PIN number which you will receive via email.