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REGISTRATION FORM
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Please Print This Form, Fill It Out & Mail With
Payment
Begin By Selecting a License Exam Answers Class Date
Below |
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[ ] May 17
& 18, 2008
(Seats
Available) |
or |
[ ] June 7
& 8, 2008
(Seats Available) |
or |
[ ] June
14 & 15, 2008
(Seats
Available) |
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[ ] Sept 6
& 7, 2008
(Seats Available) |
or |
[ ] Sept
13 & 14, 2008
(Seats Available) |
or |
_______________
OTHER CLASS DATE |
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[
] Journey Test
[ ] Master Test
[ ]
Other |
Please
Call For Other Dates |
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Today's Date
_________________________
200 ___ |
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Name |
__________________________________________________________ |
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Address |
__________________________________________________________ |
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City |
____________________________ |
State _______ |
Zip
______________ |
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Home Ph |
(
) ______
___________ |
Work Ph (
) ______
___________ |
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E-mail * |
_________________________________________________________________
*
This is optional if you ALSO want a quick
e-mail confirmation *
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CLASS COST: $379
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Pay Method:
[ ] Check
[ ] Money Order
Click here for UAW
Voucher Info
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REFUND POLICY.
If written
notice regarding class non-attendance is received by us
at least 2 (two) weeks prior to class, the student may
receive a full registration refund or class
re-scheduling. |
Non-Disclose Conditions:
All class material and
information is proprietary and private. Student
agrees not to copy, disclose or transfer in any form for
any reason any of the class material or information.
Signature:
Student certifies the information provided above is
true, correct and agrees to the
above refund policy and conditions.
STUDENT SIGNATURE
*
______________________________________________
Date
____________________
* * Signature Required * * |
Print
This Form & Mail To - - >
Checks Payable
To: CHUCK COSSIN
(248) 347 - 9000 |
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CHUCK COSSIN
PO BOX 32
NORTHVILLE MI 48167 - 0032 |
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LOCATION - Comfort Inn of
Plymouth Michigan
(734) 455 - 8100
Be Sure To Ask for The Chuck Cossin Discounted
Student Room Rate
Easy To Find (
I-275 @ Ann Arbor Rd - Exit 28 )
Friendly & Free Parking.
You Will Be Sent By Mail: A Map To The Class &
Other Helpful Class Information. |
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