|
Please
print and mail this completed form with your check or money order to:
Lessons From Abroad
PO Box 6454, Largo, MD 20792
|
Student
Information
|
|
Student Name __________________________
DOB_______________________
|
|
Parent/Guardian’s Name
______________________________________________ |
Address _________________________________________________________
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|
Phone Numbers (H)_______________ (C )
______________(W)_______________ |
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Email Address __________________________________
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In case of emergency, whom may we contact?
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|
Name ____________________________
Relationship______________________
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|
Phone Numbers (H) _________________ (C)______________ (W)_____________
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Program
Information
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Name of Program ____________________ Location ___________________
|
|
Day
_________________ Time_______________
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Payment Information
|
|
Tuition & fees |
$___________
|
|
LESS: Deposit |
$ __________ |
Date Paid _____________ |
|
Total due |
$___________ |
|
|
|
|
|
|
Please
print and mail this completed form with your check or money order to:
Lessons From Abroad
PO Box 6454, Largo, MD 20792
A confirmation email will be sent
to you as soon as your registration materials have been received.
There is a
$30 service charge
for all returned checks.
If you would like to pay by credit
card, please call us on 301-390-5559 |
