Community Education Registration Continuing Education Registration FormName* First Middle Initial Last Last 4 of SS#May be required to enroll prior to class dependent on class selection. Date of Birth* Month Day Year Gender* Male Female I prefer not to answer Phone*Email* Current Address* Current Address City State / Province / Region ZIP / Postal Code ADA Accommodations?* Yes No If yes, please list accommodations: Ethnic Origin* American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to answer Resident Status* Texas Resident Out-Of-State Resident Foreign Citizen ClassesHiddenI plan to sign up for more than one class at this time: Yes I will be enrolling in multiple classes No I will only be enrolling in ONE class at this time CE Classes - Borger CampusPlease choose from the list below of community & continuing education classes offered at the Borger campus in Borger, TXPlease make a selectionCE Classes - Borger Campus CLASS TWO CHOICEOPTIONAL: Please choose from the list below to enroll in an additional community & continuing education class offered at the Borger campus in Borger, TXPlease make a selectionCE Classes - Borger Campus CLASS THREE CHOICEOPTIONAL: Want to enroll in a 3rd class at this time? Choose from the list below of community & continuing education classes offered at the Borger campus in Borger, TXPlease make a selectionCE Classes - Dalhart CampusPlease choose from the list below of community & continuing education classes offered at the Rahll campus in Dalhart, TX Please note: If you are looking for Dalhart Community Connect summer kids camp registration visit: https://dalhartcommunityeducation.org/please make a selectionCE Classes - Perryton CampusPlease choose from the list below of community & continuing education classes offered at the Allen campus in Perryton, TX.please make a selectionTotal $0.00 Payment Method***Online payment is the preferred method of payment** If you need to pay in person, please exit this form and go to Student Central prior to the first day of class to fill out the form manually and set up payment. Pay Online Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Finals Steps:Consent*This will serve as your digital signature for the course(s) you enroll in. 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