Registration Form for the February 14th 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
*
First Name
Last Name
Student Phone
*
-
Area Code
Phone Number
Student E-mail
*
example@example.com
School
*
Grade Level
*
Please Select
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Current Composite Score
*
Please Select
Never Taken
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Goal Score
*
Please Select
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
Location
*
Please Select
Online
11515 South Memorial Parkway, Huntsville, AL 35803
Course Type
*
Please Select
Standard Course
Crash Course
Course Day/Time
*
Please Select
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
January 4th at 1:30pm
January 10th at 1:30pm
January 25th at 1:30pm
Not Sure
Will Need to Reschedule
Earliest date possible is best
Final Mock Test Date
*
Please Select
February 1st at 1:30pm
February 7th at 1:30pm
February 8th at 1:30pm
Not Sure
Will Need to Reschedule
Latest date possible is best
Emergency Contact
*
First Name
Last Name
-
Area Code
Phone Number
Additional Comments
Class Payment
*
prev
next
( X )
STANDARD Course - Feb 14th ACT
3-Point Score Increase Guarantee
$
899.00
CRASH Course - Feb 14th ACT
$
449.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: