City, State, Zip
Date of Birth (MM/DD/YYYY)
Are you a United States citizen?
If no, type of Visa:
Please select your primary racial/ethnic group:
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Pacific Islander
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Please indicate the highest degree you have earned:
Cost of course/workshop:
Check (make payabe to LLCC, mail to the address below or bring to your first day of class.
Credit Card (Discover, MasterCard or Visa) - please call 217.786.2434 to make payment by phone
After submitting your registration you will receive an email confirming your registration and you will be redirected to the Green Center website.
Please mail your payment to Julie Bates, Green Center at Lincoln Land Community College, 5250 Shepherd Road, Springfield, IL 62794-9256 or bring it to the course on the day of the event.
For more information, contact Julie Bates at 217.786.2434 or email@example.com