Mail to: Continuing Education
Millsaps
College
1701
North State Street
Jackson,
MS 39210
Make checks payable to Millsaps College.
Name___________________________________________________
Address_________________________________________________
City_____________________State_________Zip________________
Email address____________________________________________
Home Phone_________________Business Phone________________
Cell Phone___________________
Course Title(s) __________________________Day______________
___________________________Day______________
If you are charging your courses to a credit card, please fill in the
necessary information below:
______Discover ______MasterCard
______Visa
Card Number_____________________________________________
Expiration date__________________
Your Signature____________________________________________