Business/Industry and Continuing Education
Online Registration
 
 
(Registration Phone Numbers)
 
Continuing Education:  1-888-336-3907
Clinton Community College:  (563) 244-7100
Muscatine Community College:  (563) 288-6100
Scott Community College:  (563) 441-4100
 
 
 
 
Dot image  This link will take you to the printable mail-in or fax registration form.
 
Note: EICCD does not maintain a secure server connection. You can complete this form, select the submit button and your information will be automatically received by our registration department. You will then need to mail in your payment separately. Please note the course number on your check. If you prefer, you can also complete this form, print it out and mail it in with your payment. For more information call 1-888-336-3907 (toll free).
 
Fields with a  *  are required.
 
1.  * First Name: 
  * Last Name: 
 
 For companies:
 Add any additional names in the "Comments" box below.
 The name below will be the company contact person.
 
2.  Company Name or Vendor number: 
 
3.  * Address: 
 
4.  * City:    * State: 
 
5.  * Zip Code: 
 
  (please include your area code)
6.  * Day Phone: 
 
  (please include your area code)
7.  Night Phone: 
 
8.  E-mail Address: 
 
9.  Pro. License No. (if applicable) : 
 
10.   * Class No.:     * Tuition/Fee:  $
  * Class Title: 
 
    Class No.:       Tuition/Fee:  $
    Class Title: 
 
    Class No.:       Tuition/Fee:  $
    Class Title: 
 
    Class No.:       Tuition/Fee:  $
    Class Title: 
 
    Class No.:       Tuition/Fee:  $
    Class Title: 
 
11.  * Total Tuition Fees  (for companies, total of all employee fees):
  Press here for your total.      
 
12.  * Payment Plan (please check one) :
  Mail in a check
  Company billing
  Will call with credit card number
 
Comments Box:
 Add any comments, or additional employees for
 companies, or additional information requested.
 
  
 
Payment Information
 
For Individuals:
Make a check with the class number(s) and student's SS# written on the lower left hand corner, payable to Eastern Iowa Community College District (EICCD).
 
Send check or money order to:
Dot image Eastern Iowa Community College District
Dot image Attn: Registration
Dot image 306 West River Drive
Dot image Davenport, Iowa 52801, or call 1-888-336-3907 to give us your credit card information.
No cash please.
 
For Company Billing:
For each student include (in the "Comments Box" above) name. Also include the total amount due in step #11 above.
 
Registration and Refund Procedure:
All tuition and fees must be received by the published "fees due" date to ensure your registration in the class. Registration and fees are accepted after this date if space exists in the class. Refunds are made only if you cancel your registration in a class prior to the published "fees due" date.