Registration & Payment Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Online Conversation Course

A 6 Month Course - ONLY $50 EVERY MONTH

Recorded Classes/Homework/Quizzes

**Certificate of Completion when you finish the 6 month's course

Email *

***Please share flyer with friends.***

This Course begins on the 1st MONDAY of the month

Check your EMAIL for updates

First and Last Name *

Phone number *

Where do you live?

What is your zip code?

Have you studied English before? When and how much?

How is your English? 1-4

*teacher will call you to check your level of speaking

LEVEL 1 - Reading=Yes, Understanding=No, Speaking=No

LEVEL 2 - Reading=Yes, Understanding=a little, Speaking=only a few words

LEVEL 3 - Reading=Yes, Understanding=some, Speaking=some, but I need help

LEVEL 4 - Reading, Understanding & Speaking is good. I need Practice & Vocabulary

I don't know my level- The teacher will call you to help you

How did you learn about our Course? *

Facebook

Instagram

SnapChat

Friend

Other:

PAYMENT - You are only paying for ONE MONTH TODAY

*other payments are due on the 1st of each month

**this is NOT an auto payment

$50 for ONE MONTH ONLY of recorded lessons with weekly homework/quizzes (teacher available for questions)

Do you have any questions?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report