**All fields are required and must be completed in order to submit this form**

Name (Last, First, MI):

Address:

City/State/ZIP:

Social Security Number:

Area of Study:

Home Phone:

You MUST make a reservation for the session you plan to attend. Attendance at each session is limited to ensure that students receive individual attention. Please indicate on the reservation form a first, second, and third choice. Reservations are made on a first-come, first-served basis. If your chosen date is full, you will automatically be assigned to your second choice. We are not able to accept faxed reservations or phone reservations.
Day-of-program registrations are not allowed.

EFFECTIVE FALL 2007 -- Payment is a $30 non-refundable registration & orientation fee.
Credit card information MUST be submitted with reservation form.
Payment Type: Mastercard VISA Discover American Express

Credit Card Number Expiration Date
(Please enter 16 digit credit card number)

Name as printed on credit card