Please print this form, complete it legibly and fax or mail it with a check or credit card information. Or register in person or by phone, Monday through Thursday from 11:00 am to 6:00 pm: (PLEASE PRINT CLEARLY)
NAME (Ms./Mrs./Mr.) ______________________________________________________________
ADDRESS ______________________________________________________________________
CITY ____________________________ STATE_________ ZIP CODE__________
TELEPHONE: Home _________________ Office _______________ Fax __________________
E-MAIL: ______________________________________________________________________
COURSE SELECTED:_______________________ Day of course __________ Time ________
TODAY’S DATE: ___________________ CLASS FEE: _________
METHOD OF PAYMENT: ___ By check made payable to “Parliamo Italiano” ___ By credit card: Visa___ MC ___ AMEX ___
Card number ________________________________ Expiration date ________
Signature_______________________________________________________
Please note registration dates. There is a non-refundable late registration fee of $10 after these dates.
| Fall 2010 | October 6th - December 18th 2010 |
NOTE: Please see Rates page for refund policy.