Metropolitan Community Colleges-Blue River Community and Continuing Education 
20301 East 78 Highway, Independence, MO 64057 
Phone: (816) 604.6518 

Registration Form
This form is for NON-CREDIT classes only!

Registration Instructions:
For class registration, please print this page, complete the form, then mail, fax or deliver to:
Address:
Metropolitan Community College-Blue River
Attn: Continuing Education Department
20301 E. 78Hwy.
Independence, MO 64057
Fax: (816) 220.6595

You may also enroll by calling (816) 604.6518.
Name: Social Security #:
Company Name (if applicable):
Street Address:
City, State & Zip Code:
Home Phone: Work Phone:
Birthdate: E-mail (optional)
Course Title
Starting Day & Date
Start Time
Location
Fee
         
         
         
         
         
         
         
Payment
(circle one):
Check (enclosed)
Visa
MasterCard
Discover
Total Fee: $ Card # Exp. Date:
Signature (same as on card):

Thank you for becoming a member of the MCC-Blue River family!

If you need an accommodation due to a disability under the Americans with Disabilities Act,
please inform us immediately.  A two-week notice is appreciated.