In-Person ACT Prep Registration Form
Submitted to Advantage Educational Programs
Student Information
*required information
First Name
*
Last Name
*
Student Email (student will also have access to the Online Prep Course)
*
Secondary Email (payment confirmation will be sent to this address)
*
School
*
Year Graduating
*
YYYY
Parent Information
First Name
*
Last Name
*
Primary Phone
*
###-###-####
Secondary Phone
###-###-####
Street Address
*
Address Line 2
City
*
State
*
Zip Code
*
Course Information
In the fields below, enter the course numbers listed on the class schedule for the classes you would like to take.
# First Choice (3 digits)
*
# Second Choice (3 digits)
Payment Information
Courses
*
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In-School ACT Prep Course
$
180.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: