New York State Security Guard Program - Monroe Community College
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1
2REGISTRATION FORM
NEW YORK
By Phone:
Call (585) 753-3707. Be ready with course
information and Visa/MasterCard information.
STATE
By Mail:
Send this form with payment to Monroe
Community College, Public Safety Training Center,
SECURITY
Security
Guard
Training,
1190
Scottsville
Road,
Rochester, NY 14624
By Fax:
Send this form with payment information to
GUARD
(585) 753-3850
Cancellation Policy:
Students will be notified prior to the
PROGRAM
start of class if enrollment is insufficient to hold class.
Name________________________________
Spring / Summer 2016
Date of Birth___________________________
Street________________________________
City_________________________________
State_____________ Zip Code___________
Email address:_________________________
Telephone: Home______________________
Cell________________________
Work_______________________
Course Date_________________________
Check/Money Order Amount $___________
Payable to Monroe Community College
MONROE COMMUNITY
CHARGE AUTHORIZATION
I authorize you to charge my:
COLLEGE
__Visa __ MasterCard in the amount of $_______
PUBLIC SAFETY
__________________________________
TRAINING CENTER
Account Number
1190 Scottsville Road
Expiration Date_____________________
Rochester, NY 14624
_________________________________
(585) 753-3707
Card holder’s name
Fax (585) 753-3850
_________________________________
Card holder’s signature
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