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 Trumbull,  Connecticut  06611  Attn:Nathalie O'Donald Phone: 203-365-8912   Fax: 203-365-8846