Course Registration Form

Student Registration Form

Fill out the form carefully for registration. All students must pay a non refundable $50 registration fee prior to filing out this form.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*

Area CodePhone Number
Contact Number (If another party or company will be paying for your fees)

Area CodePhone Number
Company/High school Contact
Courses*
Date you would like to start

MonthDayYear
Date
Additional Comments
Should be Empty:

Student Registration Form