Registration Form for the July 11th ACT Test Prep Course
Fill out the form carefully for registration
Parent Name
*
First Name
Last Name
Parent Phone
*
-
Area Code
Phone Number
Parent Email
*
Email
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Name
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First Name
Last Name
Student Phone
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Area Code
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Student E-mail
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example@example.com
School
*
Grade Level
*
Please Select
7th Grade
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Current Composite Score
*
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Never Taken
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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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Please Select
Standard Course
Crash Course
Course Day/Time
*
Please Select
Mon/Wed 3:30-6pm
Mon/Wed 6-8:30pm
Tues/Thurs 3:30-6pm
Tues/Thurs 6-8:30pm
Sat/Sun 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
June 14th at 1:30pm
June 20th at 1:30pm
Not Sure
Will Need to Reschedule
Earliest possible is best
Final Mock Test Date
*
Please Select
July 3rd at 1:30pm
July 5th at 1:30pm
Not Sure
Will Need to Reschedule
Latest possible is best
Emergency Contact
*
First Name
Last Name
-
Area Code
Phone Number
Additional Comments
Class Payment
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STANDARD Course - July 11th ACT
3-Point Score Increase Guarantee
$
899.00
CRASH Course - July 11th ACT
$
449.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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