The Florence Melton Adult Mini-School 
Registration Form

Name:                                                                                                                             
Address:                                                                                                                        

City:                                                                                                                               
Zip:                                                                                                                                 
Daytime Phone:                                                                                                             
Evening Phone:                                                                                                              
Fax:                                                                                                                                 
E-mail:                                                                                                                            

Please check your preference. If you have a first and second choice, please indicate. Evergreen schedule will be based on student preference.

Denver Campus
__Monday evenings  __Thursday mornings
__Tuesday mornings __Thursday evenings
__Evergreen Campus
__Tuesday mornings __Tuesday evenings
__Boulder/Menorah Campus
__Fort Collins Campus

Payment Information
____$495 enclosed.
____ I have already spoken to Maggie Miller about arrangements for financial assistance. ____ is enclosed.

Payment by
__check (make checks payable to CAJE)
__credit card __ MC __Visa
Card number: __________________________________
Expiration date:____-_____
Signature:______________________________________

Return to:
Colorado Agency for Jewish Education
Attn: FMAMS
300 South Dahlia Street, Suite 101
Denver, CO 80246
Fax (303) 321-5436

For more information call
Maggie Miller at 303-321-3191 ext. 17