Register

REGISTRATION FORM

* Indicates required field

Student Name *

First

Last

Email *

Student Address *

Parent Phone *

School Presently Attending/Grade *

Student Phone *

Prior ACT Test Dates and Scores *

Option: Reading/English Course # (specify option number below) *

Option: Math/Science Course # (specify option number below) *

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Any additional information that may be helpful: Please submit your class registration form separately from payment. *

Submit Registration Form

When submitting payment through Paypal, please enter the total amount manually.
Math/Science Class $145
Reading/English Class $145
Both Classes total $290

Please submit with payment or mail with payment to:

Julie Berhorst
5116 Coventry Waye
Jefferson City, MO 65101

573-690-7065

berhorst@gmail.com

Please pre-register to ensure a spot in the class. Thanks so much!

All classes located :

5116 Coventry Waye, 65101