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NEW!
REGIS
TE
541-9 R TODAY
17-4
840
Classes for 14-18 year olds
Geocaching
Backyard
Beekeeping
Art & Etsy.
Hey, Cool Shirt
Mosaic Mashup
Teen Ranch: Horse Camp3
Digital Storytelling
Pizza. Pizza. Pizza
Summer Programs
C l a s s e s f o r T EE N S 1 4 - 1 8
The Great Cookie Bake-Off
The Open-Minded Omelet
On the Prairie:
Sewing by Hand
Sewing the Future
Mountain Bike Mojo
Under the Hood
Radio DJ
To Register
• Call 541-917-4840
• Submit the form
on the back to
[email protected]
• Visit www.linnbenton.edu/
CommunityEducation
Presented by
6500 Pacific Blvd. SW
Community
Education
Albany,
OR 97321-3755
Registration
Office Use Only
Rec’d by/date:
Community Education
Term:
Summer 
Fall 
Winter 
Spring 
Date:
LBCC ID#
or SSN#*
*Providing your Social Security number is voluntary. If you provide it, the college
will use your number for keeping records, doing research, and reporting. The college
will not use it to make any decision directly affecting you or any other person. Your
SS number will not be given to the general public. If you choose not to provide your
number, you will not be denied any rights as a student. Please read the statement
with the registration information in the class schedule which describes how your
number will be used. Providing your Social Security number means that you consent
to use of the number in the manner described.
Please Print. Fill Out Completely
Last name:
First Name:
Middle Name:
Maiden Name:
Email:
Birth date:
 Male
 Female
Permanent Address (not PO box or dorm):
Street Address:
City:
State:
Zip:
County:
Phone (primary):
Phone (other):
City:
State:
Mailing Address (if different):
Street Address:
Zip:
Demographic Information The following information is required on federal reports and affects funding, which allows us to maintain lower tuition charges.
Ethnic data is required for institutional compliance with the Civil Rights Act of 1964.
 Hispanic or Latino
 Not Hispanic or Latino
 Other
Have you lived in Oregon or a border state for
the 90 days prior to the start of the term?
Yes 
No 
CRN #
Are you a United States Citizen or Resident Alien?
Yes 
No 
If no, indicate type of visa:
Start
Time
Course Title
Fee
Instructor
Payment required at time of registration.
Credit card information will be destroyed after processing
 Check (payable to LBCC)
 Visa
 MasterCard
 Discover
Card number:
Name on card:
 American Express
Exp. Date:
Amt:
$
V-Code (3-digits on back):
Signature:
Persons having questions about or requests for special needs and accommodations should contact the Disability Coordinator at LBCC, 541-917-4789
or via Oregon Telecommunications Relay TTD at 1-800-735-2900 or 1-800-735-1232. LBCC is an equal opportunity employer and educator.