Phone Contact Coupon Form @ Global Elites Network Xpeed Learning Academy (xForm #PCC-123) CALL 929-244-9944 NOW for $100
By filling in this form, you have authorized the Xpeed Fun staff to contact you through the phone calls and Emails. Xpeed Fun will not share any private information with a third party but for its own operations of Xpeed Fun Summer Camps, Year-Long Xpeed Tutoring Centers, and Xpeed Learning Tours.
Section I: Parents or Guardians
Parent's Full Name (First + Last) *
Your answer
Phone Number # *
Your answer
Phone Location *
Expected Call Date and Time by the Xpeed Staff (Blank Means Anytime)
Your answer
Parent's Email Address *
Your answer
WeChat/Facebook/Other Social Media Connect ID
Your answer
Another Phone or Parent to Contact? (Full Name, Phone #)
Your answer
Section II: Xpeed Fun Programs
Xpeed Fun Program Interested *
How Did You Know Xpeed Fun Accelerated Learning Programs? *
Attended an Xpeed Open House Seminar on Weekends? *
Interested Location of Xpeed Fun Camp or Xpeed Tutoring Center *
If Other Location, Please Specify Town or Address
Your answer
Interested Level *
100% Enroll
Section III: Student
Student's Full Name (First + Last)
Your answer
Student's Mother-Tongue Speaking Language *
Student's Gender *
Origin of Nation
Your answer
English Proficiency
Student's Current Grade Level (Just Finished) *
Student's Overall Performance in his/her own School *
Student's Academic Strength and Weakness:
Your answer
Student's Special Needs
Your answer
Remark - Additional Information
Your answer
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