Full Name* First Name Last Name E-mail* Tuesdays 7:00-8:30pm Tuesday, May 17 Tuesday, May 24 Tuesday, May 31 Tuesday, June 13 Tuesday, June 20 Will you be attending all of the days? Yes No Number of Attendees* Number of Attendees* Number of Classes Attending:* 1 Attendee Number of Classes Attending:* 2 Attendees Number of Classes Attending:* 3 Attendees Number of Classes Attending:* 4 Attendees Number of Classes Attending:* 5 Attendees Which classes would you like to attend? 12:00-1:30pm Tuesday, February 8 12:00-1:30pm Tuesday, February 15 12:00-1:30pm Tuesday, February 22 12:00-1:30pm Tuesday, March 1 12:00-1:30pm Tuesday, March 8 12:00-1:30pm Tuesday, March 15 Which classes would you like to attend? 12:00-1:30pm Tuesday, February 8 12:00-1:30pm Tuesday, February 15 12:00-1:30pm Tuesday, February 22 12:00-1:30pm Tuesday, March 1 12:00-1:30pm Tuesday, March 8 12:00-1:30pm Tuesday, March 15 Which classes would you like to attend? 12:00-1:30pm Tuesday, February 8 12:00-1:30pm Tuesday, February 15 12:00-1:30pm Tuesday, February 22 12:00-1:30pm Tuesday, March 1 12:00-1:30pm Tuesday, March 8 12:00-1:30pm Tuesday, March 15 Which classes would you like to attend? 12:00-1:30pm Tuesday, February 8 12:00-1:30pm Tuesday, February 15 12:00-1:30pm Tuesday, February 22 12:00-1:30pm Tuesday, March 1 12:00-1:30pm Tuesday, March 8 12:00-1:30pm Tuesday, March 15 Which classes would you like to attend? 12:00-1:30pm Tuesday, February 8 12:00-1:30pm Tuesday, February 15 12:00-1:30pm Tuesday, February 22 12:00-1:30pm Tuesday, March 1 12:00-1:30pm Tuesday, March 8 12:00-1:30pm Tuesday, March 15 Which classes would you like to attend? Tuesday, May 17 Tuesday, May 24 Tuesday, May 31 Tuesday, June 13 Tuesday, June 20 Student Textbook:* Please ship to my home. I will pickup at the first class. Total $0.00 I would like to pay today: Full amount $0.00 minimum $ Payment Credit Card I'd like to try the first class at no charge (no payment required at this time) Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Expiration Year Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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