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Contact us today!
877-532-3370
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Registration form
416 W. State St.
Geneva, IL. 60134
630-377-8794 Fax 630-578-0948 |
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I am registering for the _____________________class on ________________ at _____________.
(language) (day(s) of week) (time)
Register by Fax: Fax registration and credit card information to 630-578-0948.
Register by Mail: Mail completed form and payment to 416 State St. Geneva, IL. 60134
Please complete one form for each student. Make check payable to: Foreign Language Network.
Name:_________________________________________________________Age:______________
Parent name:_____________________________________________________________________
Street:_______________________________City___________________Zip________ __________
Home phone:_________________________Cell phone:__________________________________
Emergency contact:_________________________________Phone:_________________________
Email address:____________________________________________________________________
We will confirm your registration via email. Email addresses are kept confidential.
AutoPay (tuition is broken down into monthly payments)
I would like to sign up for AutoPay and have my credit card charged on the 1st of each month. I understand the tuition is pro-rated each month, therefore I will only be charged for the number of classes that meet each month. I understand that in order to cancel or suspend Autopayment, I must call the billing center at 630-377-8794 before the 1st day of the month.
_____________________________________________
(signature)
credit card information is kept confidential and only viewed by company owner.
Credit Card Payment Visa:____ Mastercard:_____
Cardholder:______________________Card number:______________________Exp. date: _______
Signature:___________________________________________Amount:____________or Autopay
Security Code (the three digit code on the back of your card) ______________________Insert text |
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