Mattapan Tech Membership Application Form
Class registration: Before filling the registration form, please take a few minutes to read Mattapan Tech's policy and have your credit card ready to pay the membership fee. If you plan to pay by check or money order feel free to click on the following link http://mattapantech.com/Registrationpackage.pdf to print a hard copy of the application and mail it to: Mattapan Tech, 24 Regis Rd., Mattapan, MA, 02126.

Complete the form below only to register for courses. Incomplete applications will not be processed. You need a Visa or MasterCard to register online. It is illegal to submit the registration form with a fake or invalid credit card , you may jeopardize your chance to secure a seat at Mattapan Tech or any other institution affiliated with the United Christian Fellowship Urban Ministries. If you need help filling the registration form call: (617) 298-0357.

* Mattapan Tech is a self sustaining non-profit organization. Membership fees are subject to change based on funds available to run these programs. Register now and secure the current low membership fees for the program that you selected. No tuition - No loans

Before you sign up for a class make sure to read our policies http://www.mattapantech.com/MTLC/policies.htm

Email address
Applicant Full Name (First, middle and last name)
Your answer
House Number, Street Name, Apt. #
Your answer
City, State and Zip Code
Your answer
Phone Number
Your answer
Select your course date and time:
Please read the text below before selecting your course
How did you hear about Mattapan Tech workforce development program?
Have you read our policies ?
We want to make sure that you understand our refund and graduation policies.
Enter your Date of Birth (You must be 18 or older to submit this application)
Your answer
1) You understand that Mattapan Tech is a non-profit charitable organization. 2) The registration fee is non-refundable except if the class is cancelled.
Required
Type your name below to sign that you have read and understand Mattapan Tech policies. You certify that you are not under any drug or alcohol influence and no one forces you to agree with our policies.
Your answer
Select your credit card
Name on the credit card (Ex: John Doe)
Your answer
Full billing street address (if different from above)
Your answer
Billing address City & State
Your answer
Billing address zip code
Your answer
Credit card number
Your answer
Card Exp. date MM YYYY Ex: 01 2017
Your answer
The card 3-digit security code.
Your answer
Give 2 personal references (names and phone numbers)
Your answer
Employer name:
Your answer
Employer phone number:
Your answer
By submitting this form you agree and authorize Mattapan Tech to charge your credit card for the membership fee and lab fees indicated for the program that you selected. In addition Mattapan Tech will charge you a 3% processing fee. You understand that these membership and lab fees are not refundable, with the only exception being if the class is cancelled. Click "Yes" in the box immediately following this statement.
Required
Today Date:
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YYYY
Type your name to sign the registration form
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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