Math Content Refresher Courses

Credit Card Form

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

 


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

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 ($589 per course)
Preferred payment method:             Authorization (on card back - last 3 numbers)
Credit Card Number:  Expiration date: Month Year: 
First Name:     Last Name
Street Address:
City: State: Zip:
Phone number (with area code): ()
E-mail address:

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