"Raise Your IQ"  (Italian Quotient)

Printable
Registration Form

 

Click here to print this page

 

For which class are you enrolling?

  
  For how many are
you pre-registering?

Tampa Italian
4-Week Class
 Castellano & Pizzo
Tampa Italian
8-Week Class
 Castellano & Pizzo

Sarasota
   

Palm Harbor
Positano's Ristorante Italiano

Tierra Verde

St Pete Beach
 SPB Rec Center

Tampa Spanish
Castellano & Pizzo
St Pete Beach
Spanish
 SPB Rec Center

Intermediate
Italian
Castellano & Pizzo

One

 ________

Two

 ________

Three

 ________

Other

 ________

   Name   

  Address

  City, State & Zip

  Home Phone #                                   Work #                                   Cell # 

  E-Mail Address for Class Confirmation

How did you find out about the class?

Internet____ 

Flyer____

Newspaper____

Other_____________

A $50.00 deposit for each student is required to secure your admission.  This deposit will be applied to the entire cost of the class and is non-refundable should you cancel less than fourteen days prior to the start of your class. In the event of a class cancellation by Learn a Language Inc. deposits and payments in full will be refunded in full.

Please mail form with full payment or $50 deposit to secure your admission.
Make check payable to: Learn a Language Inc.

Amount Enclosed____________________

Include this form with your payment.  If you cannot print this form, you can also answer these questions on a separate piece of paper and include it with your payment.

OR

IF you paid online,  please check here>>

Mail To:

 

Learn a Language Inc.
4905 34th. Street South
Suite 135
St. Petersburg, FL.   33711
 

I understand the terms and conditions of this agreement.

Signature___________________________________Date ___________________
*Class cancellation must be made 14 days prior to class time.  The Deposit is non-refundable.