REGISTRATION FORM
PAYMENT MUST ACCOMPANY REGISTRATION AND IS
NONREFUNDABLE.
If paying by credit card or school purchase order,
registration and payment can be faxed to 321-452-6244.
If paying by check, please mail registration and check to:
The Astronauts Memorial Foundation
Mail Code AMF
Kennedy Space Center, FL 32899
Title:__________________________________________________________
E-Mail Address:_________________________________________________
School Name:__________________________________________________
School Address:________________________________________________
City:_________________________________________________________
State:_____________________________ZIP:________________________
Phone: ________________________Fax:____________________________
School District:________________________________________________
Selected Course(s)
Space is limited. Your first choice will be honored whenever possible. Updated
information regarding class availability will be posted on our web site.
Course Name:______________________ Course Name:________________________
Session Code:_____________________ Session
Code:________________________
1st Choice:________________________ 1st
Choice:__________________________
2nd Choice:_______________________ 2nd
Choice:__________________________
Payment Method
The following information must be completed before registration can be processed.
Please indicate method of payment.
_____ Purchase Order Number ______________
_____ Check (made payable to AMF)
_____ MasterCard
_____ VISA
Account Number
__________________________________
Expiration
Date:____________
Signature of Cardholder: ___________________________________
Confirmation
of your registration will be
sent via post mail.