| Pre
- Registration Form |
|
| First
Name |
|
| Last
Name |
|
| Street
Address |
Apt.
|
| City |
|
| State |
|
| Zip Code |
|
| Home
Phone |
|
| Secondary
Phone (optional) |
|
| Email:
|
|
| Date
you would like to start? (Classes begin every Monday) |
(PLEASE NOTE: Start dates are NOT guaranteed. Please call to schedule.
Dates are subject to change based on available seating.
) |
| Preferred classed schedule (please select one): |
(NOTE: class schedules are flexible and can easily fit
your schedule) |
| Preferred location |
|
| Pre-Registration
Payment Information |
|
Registration Amount: |
$100.00 |
| Program
Price |
$299.00 |
| Full
Amount: |
$399.00 |
| Type
of Card |
|
| Full
Name (as it appears on card) |
|
| Same
Address as above |
|
| Street
Address |
|
| City |
|
| State |
|
| Zip Code |
|
| Card
Number |
|
| Exp Date |
|
| 3
Digit V-Code (on back of card) |
|
|
NOTE: Checking the "Terms of Agreement" check box below is the same as signing and dating the contract.
By checking this box and submitting the form, I accept the above terms and conditions and agree that all info entered was done accurately & truthfully.
I understand and accept the Terms of Agreement: |
|
|
