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Student Name:                                                            
Full name to go on diploma:                                                            
Business Name:                                                             
Address:                                                            
City:                                    Postal/Zip Code:                                
Home Telephone:                                                            
Work Telephone::                                                            
Fax No.:                                                            
Email:                                                            
Date of desired class:                                                            
Method of Payment: M/C  AMEX   VISA  Certified Check  Money OrderMoney Wire

Please enclose your deposit payment with this registration of $1,000.00.
Card  No.:                                                            
Expiry Date:                                                            
Card Holder's Signature:  

______________________________

 

We reserve the right to change dates and times of classes no later than seven days before your registered class.
I have read this application form and I fully understand everything contained herein. I also agree to all the
provisions stated on this form.

Signed, this __________  day of _______________ in the year of __________.

Signature of Applicant:______________________  

Name (please print):