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WGTC Continuing Education Registration Form (Valdosta & Cook Campus Areas)
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Course Name *
Course Date *
MM
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DD
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YYYY
Course Fee *
Enter the registration fee (i.e. $00.00).
Course Location *
First Name *
Middle Initial
Last Name *
Address *
City *
State *
Zip *
County *
Primary Contact # *
Enter the primary telephone number where you can be reached.
Secondary Contact # *
Enter an optional telephone number where you can be reached.
Date of Birth *
Email Address *
Employer *
Gender *
Ethnic Origin/Race *
*This voluntary information is required for purposes of reporting to Federal Compliance agencies only and will not be used in determining registration status.
U.S. Citizen *
Number of Years You Attended School *
Method of Payment Preferred *
*If you prefer to pay with a debit or credit card, please call Chymeka Gibbs at 229-333-2122 or Jackie Veuleman at 229-219-1379 to provide payment information. If you prefer to pay with cash or a check, please visit Chymeka or Jackie at our Valdosta Campus. If you prefer to mail a check, please make it payable to WGTC and mail payment to WGTC, ATTN: Chymeka Gibbs, 4089 Val Tech Road, Valdosta, GA 31602.)
Agreement
Course Fees/Registration:  Continuing Education course fees must be paid in advance of class start date.  Cash, Check, Money Order, Discover, MasterCard, or Visa is accepted.  You are officially enrolled and your name is placed upon the class roster as soon as we receive your registration form and payment.  Students accepted first day of class on a space available basis only.

Refunds and Cancellations:  Full refunds will be given by contacting the Continuing Education office for cancellations at least 48 hours (2 working days) prior to the beginning of the program if payment was made in person, by mail, or via phone.  For cancellations with less than 48 hours (2 working days) notice prior to the beginning of a program NO refunds or credit will be given.  Wiregrass reserves the right to cancel, postpone, limit enrollment, split or combine classes, and change instructors and class locations when necessary.  For classes cancelled by Wiregrass Georgia Technical College, registrants are given full refunds.

Services to Students with Disabilities:  Wiregrass Georgia Technical College is committed to providing individuals with disabilities equal access to higher education.  Any student in need of testing or classroom accommodations due to a documented disability should contact the  Special Populations Coordinator for an appointment to discuss support services.  For Atkinson, Ben Hill, Coffee, and Cook counties, contact Amanda Walker by telephone at (229) 468-2242 or by email at amanda.walker@wiregrass.edu. Valdosta students should contact Katrina Royal by telephone at (229) 333-2100 ext. 1236 or by email at katrina.royal@wiregrass.edu.

WGTC is accredited by the Commission of Colleges of the SACS.  A Unit of the Technical College System of Georgia, Equal Opportunity Institution.
I understand and accept the conditions outlined in the agreement above. *
Type your name in the textbox below to indicate acceptance of the conditions outlined in the agreement. *
Type first and last name.
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