Registration Form for the December 13th ACT Test Prep Course
Fill out the form carefully for registration
Parent Name
*
First Name
Last Name
Parent Phone
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Area Code
Phone Number
Parent Email
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Email
Address
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Street Address
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Student Name
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Student E-mail
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example@example.com
School
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Grade Level
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Goal Score
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Location
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Online
11515 South Memorial Parkway, Huntsville, AL 35803
Course Type
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Standard Course
Crash Course
Course Day/Time
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Mon/Wed 4-5:30pm
Mon/Wed 5:30-7pm
Mon/Wed 7-8:30pm
Tues/Thurs 4-5:30pm
Tues/Thurs 5:30-7pm
Tues/Thurs 7-8:30pm
Saturdays 1:30-5:15pm
Sundays 1:30-5:15pm
Is the student taking the science test?
*
Please Select
Yes
No
Not Sure
The science test is now optional.
Diagnostic Test Date
*
Please Select
November 2nd at 1:30pm
November 8th at 1:30pm
November 16th at 1:30pm
Not Sure
Will Need to Reschedule
Earliest date possible is best
Final Mock Test Date
*
Please Select
November 23rd at 1:30pm
December 6th at 1:30pm
December 7th at 1:30pm
Not Sure
Will Need to Reschedule
Latest date possible is best
Emergency Contact
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First Name
Last Name
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Area Code
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Additional Comments
Class Payment
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STANDARD Course - Dec 13th ACT
3-Point Score Increase Guarantee
$
899.00
CRASH Course - Dec 13th ACT
$
449.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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