Spanish Language Center

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 read the following:

Check here to acknowledge the terms of registration:

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

 

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