Registration Form - Beechwood ACT Prep, Inc.
After submitting this electronic form, please check your email for the mailing address (2417 Ambrato Way, Fort Mitchell, KY 41017). If you don't see an email from Google Forms or an email from Beechwood ACT Prep, Inc., check your "Junk" or "Clutter" folders, especially if there are restrictions on your email server.

Once you submit your registration form, our mailing address (2417 Ambrato Way, Fort Mitchell, KY 41017) and our payment methods will also appear.

You will receive a Payment Confirmation email from info@beechwoodactprep.com with all of the pertinent class information AFTER your payment is received.
Email address *
Registration
Please fill-out this registration form to let us know that you want to come to our class. However, your spot in the class is only secured with your payment. If we do not receive payment, we will contact you the week before the class starts to remind you to secure your spot with payment. We have a variety of accepted payment methods: check, money order, cash, Venmo, and payment plans. Please read the email that you will receive upon completion of this form.
Please choose the SESSION that you would like receive 24 hours of ACT Prep - All Four Subjects *
Required
Which scenario best describes your registration? *
Required
What is the student's last name? *
What is the student's first name? *
What high school does the student attend? *
What is the student's graduation year? *
Required
Parent/Guardian Email Address *
Student Email Address *
Parent/Guardian Phone Number Please enter using this format: (555) 555-5555 *
Student Phone Number Please enter using this format: (555) 555-5555
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