Winning in Math Registration Form / 6th - College
Please provide the following contact information:
Today's Date:
Student's Name:
Parent's Names:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Parent(s) Work Phone
Home Phone
E-mail

School Attending:
Grade:
Student's Academic Strengths:
Student's Academic Weaknesses:

Does the student have any learning differences about which we should be aware?

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If so, please explain:

To hold a seat in our course, a $50 deposit is required. Please provide credit card information below:
Name on Card:
Card Number:
Expiration Date:

Workshop date for which student is registering:
How did you hear about
Total Learning Concepts?:

Student Enrollment Fee: $65 (not applicable to previously enrolled TLC students)
Workshop Fee: $130 + $15 materials
Course Length: 4 - 4.5 hours


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Revised: April 9, 2011
             
Copyright © 2015 Total Learning Concepts, Inc. All Rights Reserved