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Class Registration Form

click here for Terms and Conditions

 

Class Title
Class Date
Class Location
First Name
Last Name
Student Telephone
Student Email
Agency Name   
Agency Address 1
Agency Address 2
Agency City
Agency State
Agency Zip
Agency Telephone 
Agency Email 
Tuition

 

for multiple students, please complete one form for each.

  

Payment method:

Card #:     Exp Date: /                  

or Purchase Order #

(please fax purchase orders to (509) 464-2045)

 

(Please fill out following if information is different from above.)

Bill To:

 

Thank You !