Training Registration Form

To register for a course, please complete the form below. If you prefer to mail or fax your registration form, you may download a printable version here.

*required
**Needed for statistical reporting purposes only.

Name:		*required
Address:
City:
County:
State:		Georgia Florida
Zip Code:
Daytime Phone Number:		*required
Evening Phone Number:
Email:		*required
Place of Employment:
**Highest Educational Level Attained		-- Select Highest Level -- GED High School Some College/Technical School College/Technical Degree
Date of Birth:
**Sex:		-- Select Sex -- Male Female
**Race:		-- Select Race -- Caucasian Black Hispanic Oriental Native American Other
Workshop Title:		*required
Class Date:		*required
Workshop Title:		(optional)
Class Date:		(optional)
Workshop Title:		(optional)
Class Date:		(optional)

Note: Workshops with minimum enrollment are subject to cancellation. 100% refund for canceled class or 2 days prior notice.

Statement of Assurance
As set forth in its student catalog, Moultrie Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability,age, political affiliation or belief, disabled veteran, veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or mandated by law)Moultrie Technical College is a multiple campus institution of higher learning whose mission as part of the Technical College System of Georgia is to provide a culture of learning through occupational education, academic education, business and industry training, and workforce development supporting the education and economic advancement of Colquitt, Tift, Turner, and Worth counties.

The college fulfills its mission by providing accessible, quality education leading to associate degrees, diplomas, technical certificates of credit, and programs to assist adults in literacy education.