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A* Accelerator Registration Form
For registration please fill this form out and pay $500 deposit. The payment information is present at the bottom of this form and on the next section based on what method you choose.
If you have any questions contact us:
Website:
www.a-staraccelerator.com
Email: contact@a-staraccelerator.com
Phone: 425-598-4338
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* Indicates required question
Student Name
*
Your answer
Student Age
*
Your answer
Student Phone Number
*
Your answer
Student Email
*
Your answer
Parent Name
*
Your answer
Parent Email
*
Your answer
Parent Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
A* Accelerator Student and Parent Agreement
Please view this agreement and let us know if you have any questions:
A* Accelerator Agreement
Read the Agreement
Yes
No
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Student Signature (Please Type Your Full Name)
*
Your answer
Parent Signature (Please Type Your Full Name)
*
Your answer
Why do you want to be a part of A* Accelerator
*
Your answer
Were you referred by anyone?
*
Yes
No
Referral Name (Please type NA if you were not referred)
Your answer
Referral Email (Please type NA if you were not referred)
Your answer
Deposit Paid ($500)
*
Yes
Method of Payment
*
Zelle (Preferred)
Wire Transfer
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