Advanced Program Registration Form
Please fill out the form below and one of our representatives will contact you.
Student Full Name
*
Student Grade Level
*
Subjects
*
Bergen County Academies Test Prep
SAT Prep
PSAT Prep
ACT Prep
SSAT Prep
ISEE Prep
SHSAT Prep
MATH
ENGLISH
CHEMISTRY
BIOLOGY
PHYSICS
LITERATURE
AP SUBJECTS Help
GRE Prep
GMAT Prep
CALCULUS Help
STATISTICS Help
GDE Prep
LSAT Prep
PRAXIS Prep
TOEFL&IELTS Prep
College Counseling Help
College Admissions Essay Help
Other
Parent E-mail
*
Parent Phone Number
*
Zip Code
Student Phone Number
*
How Did You Find Us?
Google
Facebook
Referral
Yelp
Direct Website
Physical Flyer
Other
Student Phone Number
-
Area Code
Phone Number
Monthly Advanced 1 on 1 Tutoring Plan Subscriptions
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next
( X )
Bronze
(
$
500.00
for each
month
)
Monthly 4 hours tutoring plan
Silver
(
$
700.00
for each
month
)
Monthly 6 hours tutoring plan
Gold
(
$
850.00
for each
month
)
Monthly 8 hours tutoring plan
Platinum
(
$
1,000.00
for each
month
)
Monthly 10 hours tutoring plan
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
SUBMIT
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