Registration Form for July 13th ACT Prep Crash Course
Fill out the form carefully for registration
Parent Name
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First Name
Last Name
Parent Phone
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-
Area Code
Phone Number
Parent Email
*
Email
Student Name
*
First Name
Last Name
Student Phone
*
-
Area Code
Phone Number
Student E-mail
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example@example.com
Location
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Please Select
Huntsville
Madison
Course Day/Time
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Please Select
Monday/Wednesdays 4pm-6pm
Monday/Wednesdays 6pm-8pm
Tuesday/Thursdays 4pm-6pm
Tuesday/Thursdays 6pm-8pm
Sundays 1:30pm-5:30pm
Emergency Contact
*
First Name
Last Name
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Area Code
Phone Number
Additional Comments
Class Payment
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ACT Prep Crash Course for the July 13th ACT Test
$
349.00
Quantity
1
2
3
4
Class
M/W 4-6pm (Huntsville Location)
M/W 6-8pm (Huntsville Location)
T/Th 4-6pm (Huntsville Location)
T/Th 6-8pm (Huntsville Location)
Sundays 1:30pm-5:30pm (Huntsville Location)
M/W 4-6pm (Madison Location)
M/W 6-8pm (Madison Location)
T/Th 4-6pm (Madison Location)
T/Th 6-8pm (Madison Location)
Sundays 1:30pm-5:30pm (Madison Location)
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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