PERSONAL INFORMATION
Name: Title: Mr. Miss Ms. Mrs. Rev. Fr. Sr. Br. Dr. Rabbi Other Other:
First: Middle Initial: Last (family):
Community (Preferred Name):

Home Address:
Number:
Street:
City:
State: Zip Code:
Country:

Home Telephone:
Cell/Work Telephone:
E-mail address:


Current Mailing Address (if different from above)
Number:
Street:
City:
State: Zip Code:
Country:

Billing Address :
Street Address and number
City
State Zip Code
Contact Person / Position
Country
Tax-exempt ID # (If applicable):

Are you taking course for Credit? Yes No
Institution:

Have you taken classes at MACC before? No Yes, Year?

Date of Birth: M /D / Y

for statistical purposes only

Ethnic/Racial Group: Hispanic White, Non Hispanic African-American American Indian Asian Other Other:
Education: Grade School High School Some College B.A. Master Doctorate Other Other:

Archdiocese/Diocese:

Register me for the following program(s):

Mini Pastoral Program (3-week Course) (MP)
English Spanish
Date:

Intensive Pastoral Spanish / Intensive Spanish Four 3-week session(s)
Date(s) :

HOUSING (Living Arrangements):
On-Campus,

Off-Campus, address/telephone where staying:

Special Needs (Disabilities):

Mail this form and check or money order: For MP/HPM/Workshop(s) Registration Fee $75 (Non-refundable)

Language Programs (English/Spanish): $125 for registration and testing fees (Non-refundable)

TO: MACC Registrar, P. O. Box 28185, San Antonio, Texas 78228

REV. 2/06