Student Registration

Student Registration Form

Please call if you have questions 1 800 264 1787 or 615 784 4212
First Name*
Middle Name*
Last Name*
Birthdate:*
Birthplace City & State*
Gender*
Citizenship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile Number*
Please enter a valid phone number.
Eye color*
Hair Color*
Height*
Weight in lbs*
Emergency Contact Name:*
Emergency Contact Phone number:*
147 School (If attended):*
Military Cool Program*
Deposit Not required for Cool Members
FAA Course Name*
Class Start Date*

MonthDayYear
Classes start every Monday
Name on the Card:*
Card Type:*
Deposit (Required $100.00):*
Last 4 of Credit Card:*
Place 0000 if COOL/Company paying
Special Instructions ie. Driving or flying? Will you have transportation?

Please select only one: If you want to pay in full please call us with card # after you enroll.*

Deposit

$100.00

COOL Program Still need CC info but will not be billed

$ Free

Company PaymentHave company rep call to make payment.

$ Free

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

If enrolling on your moblie device please close browser window after payment screen to prevent double charging of depoist.
Should be Empty:

Student Registration Form