SeniorNet Class Registration: FALL  2008            SrNet Priority # ______
Welcome to SeniorNet Registration.  To help us advise you and help to properly place you in the correct class,
please answer the following questions:

1. SeniorNet member?  No___  SrNet Member #__________ Exp. Date________

2. Do you own or have access to a computer?  . . . .  .  .  .  .  .  .   Yes ____  No____ 
3. “Microsoft Windows” Version on your PC?  98   ME   2000   XP   VISTA   Other
4. Do you use the Internet?         Regularly_____Occasionally_____Never_______
5. Which of the following have you done using a computer?
   1. Written a document/letter?   . . . . . . .    Yes______No______
   2. Printed out a document/picture?   . . .    Yes______No______
   3. Created a Greeting Card or Poster?  .   Yes______No______
   4. Edited/downloaded a picture?  . . . . .    Yes______No______
   5. Saved a file?   . . . . . . . . . . . . . . . . . .   Yes______No______
   6. Played games on a computer?  . . . . .    Yes______No______
6. List computer classes that you have taken.

Class:_______________________________ Institution  _____________

            Class:_______________________________ Institution  _____________

            Class:_______________________________ Institution  _____________

            Class:_______________________________ Institution  _____________

Note: If you answered no/never to questions 2 & 4, then the computer class suggested for you is: Computer Fundamentals I.

è  Maximum number of classes that you wish to take?  _____  ß Required

                        Sect.    Description                                                            Sect.         Description

Name ________________________________________________________________

            (Please print or attach return address mailing label).

Address_______________________________________________________________

City_________________________________State___________ZIP_______________.

Phone  (        )    _______--_____________  Extension ___________                           

Email Address____________________________________________________

Use this form to mail in your registration if you do not plan to attend the August 16^th  walk-in registration.  Mail it to the following address: SeniorNet, Box 3499, Peoria, IL, 61612-3499 with a $40 Check, Money Order payable to “SeniorNet.”  Or, you can provide Credit Card information.  The deadline for registrations is September 1^st.

Registration priority will be assigned as they are received.  Mail-ins included.

Below: SeniorNet Office Use Only                                                                       Month         Year

New/Renewal Membership – Check # __________          Current Membership Expiration - _________/__________

NEW & RETURNING STUDENTS: PLEASE COMPLETE PAGE 2 OF THIS FORM

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