MPC Registration Form

Print out the form, shown below, and return it with a
$25 non-refundable registration fee for each course to:

  Brenda Lepisto, Ph.D.
4572 S. Hagadorn  Road, Suite 2D
East Lansing, Michigan 48823
(517) 333-0332
e-mail: 

Please send one form for each course.

Course                                                                                                                                       

Semester:   [ ] Fall     [ ] Winter        Site:                                                                                

Name                                                                                                                                         

Address                                                                                                                                     

Occupation                                                                                                                                

Phone (Day)                                                                (Evening)                                             

E-mail                                                                 

Payment is due in full before the start of the course.