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
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: