2100 North 6th Street, Harrisburg, PA 17110
Phone: (717) 238-9540 Fax: (717) 233-5001 Email:[email protected]
www.pafairhousing.org
CAPITAL REGION COMMUNITY HOME BUYERS COALITION WORKSHOP
REGISTRATION FORM
Thank you for your interest in our First Time Home Buyers Workshop. The Workshop is designed to
assist you in understanding the details of the Home Buying Process so you can become a successful
Home Owner. You will also benefit from the expertise of professional guest speakers, time & moneysaving hints, and special programs discussed in class!
We look forward to seeing you at the Workshop!
Please complete this form, sign it, and mail it back to us at the address above.
PLEASE PRINT
Name(s): ________________________________________________________________
ADDRESS: _______________________________________________________________
CITY:
________________________ STATE_______ ZIP CODE___________________
TELEPHONE #:
_____________________ WORK # ______________________________
EMAIL ADDRESS ______________________________
DO YOU CURRENTLY RESIDE WITHIN THE CITY LIMITS OF HARRISBURG YES_____ NO______
HAVE YOU APPLIED FOR A MORTGAGE? YES____ NO_____ LENDER:___________________________________
ARE YOU INTERESTED IN THE DAUPHIN COUNTY’S DOWN PAYMENT ASSISTANCE PROGRAM? YES___ NO___
ARE YOU INTERESTED IN THE PHFA DOWN PAYMENT ASSISTANCE PROGRAMS?
YES___ NO___
MONTH TO ATTEND: ___________________(SEE ENCLOSED FLYER) REFERRED BY: __________________________
We/I, the undersigned, understand that the Fair Housing Council of the Capital Region Home Buyers
Coalition Workshop is available and that a registration fee is required in the amount of $20.00 per person
payable to Fair Housing to cover cost of materials for the Workshop. I understand that I must attend all 3
(three) sessions of the Workshop to receive a Letter of Completion. I understand that I will be able to exchange my
Letter of Completion for a Certificate from The FHC of the Capital Region, Inc. upon approval of a mortgage. The
names and addresses of all registrants will be available to Members of Fair Housing’s Coalition supporting this
workshop.
REGISTRATION FEE IS NON-REFUNDABLE AND MUST BE PAID IN CASH OR BY MONEY ORDER-
NO PERSONAL CHECKS
SIGNATURE___________________________________________________ DATE _________
Building Foundations and Strengthening Communities Since 1976