Guest / Non-Degree Registration Form

Guest / Non-Degree Registration Form
Name

First NameMiddle Name/InitialLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth

MonthDayYear
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
For Guest Students indicate College or University
List the courses you are registered for
For questions, please contact the Records Office in Berks Hall Building, Room 107, or Call: 610-607-6243, Fax: 610-607-6290, or send email: records@racc.edu.
TERMS & CONDITIONS: I acknowledge my financial responsibility and agree to pay all costs and charges necessary for collection for any amount not paid if placed in collections. I also agree to pay all attorney fees and/or legal fees and court costs to collect my unpaid balance.
You must agree to the Terms and Conditions in order to Submit this form.
Please verify that you are human
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