Cooperative Educational Services Public Catalog 
Cooperative Educational Services Course Registration Form
Person Information
Person Name:  
Social Security #:   - -
Address:  
City:      State:   Zip Code:  
Email Address:  
Phone Number:   - -
 
School Information
District:  
School:      Grade:  
Address:  
City:      State:      Zip Code:  
Phone Number:   - -
 
Activity Information
Activity Name    Activity Code   Price
Activity Name    Activity Code   Price
Activity Name    Activity Code   Price
Payment Amount
Check #    P.O.#
Invoice Me
*To mail in your registration, complete the form and send it with a check payble to:
Cooperative Educational Services
40 Lindeman Drive
TrumbullConnecticut  06611 
Attn:Tomie Rumas
Phone: 203-365-8912   Fax: 203-365-8846