Spanish Language Center :: Registration

registration

Last Name

First Name

Address 1

Address 2

City

State:

Zipcode

Phone 1

Home Work Cell

Phone 2

Home Work Cell

Email Address

Occupation

Please indicate where classes will be held:

At our locations:

Downtown, Lakeview & Palatine Group Classes

Tuition:

If you purchase 16 weeks, select level for first 8 weeks. You may schedule second course later.

Please select the class starting date (day, month, day number, time). If possible, please include a second option.

1st Choice: , at

2nd Choice: , at

Please enter the credit card information here:

Card Type:

Input Card Number:

Expiration Date: [mmyy]

Billing Zipcode:

Please carefully read the following:

By clicking submit I accept the above terms and authorize the Spanish Language Center to charge my credit card for the amount marked above.