Spanish Language Center :: Registration

registration

Live Online Class Registration Form

Student Info

Last Name

First Name

Address 1

Address 2

City

State:

Zipcode

Phone 1

Home Work Cell

Phone 2

Home Work Cell

Email Address

Occupation

Number of ONLINE classes Please choose only one of the following options and select the corresponding amount.
8 classes of 1.5 hours (12 hours)	8 classes of 1 hour (8 hours)
Tuition: The hour rate for this online-class package is $37.50 an hour. Please select the amount below.	Tuition: The hour rate for this online-class package is $40 an hour. Please select the total amount below.

Starting Date

Please indicate tentatve starting day, date and time. We will confirm with you if these days and times work. If not, we will work wtih you to get something that fits your schedule.

1st Choice:

, at

2nd Choice:

, at

Payment Information

Please enter your credit card information here:

Card Type:

Card #:

Expiration Date: [mmyy]

Billing Zipcode:

Policies about your Class and Registration

Please carefully read the following:

Policies: Privacy, Refunds, Returns & Attendance (click here)
I accept the Policies: Privacy, Refunds, Returns & Attendance:

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

Spanish Language Center