| 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? (new classes start on Monday
and Saturday) |
|
| What
class schedule do you prefer? (please select one): |
(Note: class schedules are flexible and can fit
your schedule depending on the class) |
| What
location would you like to attend |
|
| Pre-Registration
Payment Information |
|
Registration Amount: |
|
| Program
Price |
|
| Full
Amount: |
|
| 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) |
|
|
|
