Registration Form
Fill out the form carefully for registration
Student Name
First Name
Middle Initial
Last Name
Grade/Age
Gender
Please Select
Male
Female
N/A
Parent's E-mail Address
example@example.com
Name of Math Book
Phone Number
Please enter a valid phone number.
Areas of Weakness Solving Word Problems: i.e. division, multiplication, etc.
Registration
*
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Registration Fee
Registration Fee is 10.00 for each student. Each student is required to take a preliminary math (word problem) test. The test consist of 10 questions.
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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