First name: Middle initial: Last name: Preferred Name: D.O.B.: Rank: PID#: Dept: Mailing Address: City: State: Zip: E-mail: Work Phone: Please check here if your information has changed from your original LCC application. LCC Graduation Date: Check the box next to the module you wish to attend: February 4-8, 2008 - FULL Check here July 7-11, 2008 Check here
You will receive a letter confirming your registration approximately 14 days prior to the start of the module. If you have any questions please contact Carolyn Martinez at email: cmartinez@shsu.edu.
Please print out and fax to LEMIT LEMIT fax number: 936-294-3926