Math Refresher Courses

Credit Card Form

COMPLETE (Type-in) this form and then PRINT and ENCLOSE with your REGISTRATION FORM

Note: Please do NOT use this form for the Middle Mathematics course - it has its own Credit Card form

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Course(s)        Calc Refresher I  Calc Refresher II    Pre-Calc RefresherStatistics Refresher
Geometry Refresher   Algebra I Refresher Algebra II Refresher

Note: If you are signing up for more than one course, check each of them above and use this form for all courses.
          You do not have to submit a separate credit card form for each course

What is the Total Amount of this Charge ($484 per course)

Preferred payment method: Select Visa MasterCard Discover Authorization (on card back - last 3 numbers)

Credit Card Number:  Expiration date: Month Select 01 02 03 04 05 06 07 08 09 10 11 12 Year:  Select 2007 2008 2009 2010 2011 2012 2013

First Name:     Last Name

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COMPLETE (Type-in) this form and then PRINT and ENCLOSE with your REGISTRATION FORM