New Customer Registration Form
Thanks for registering with Fusion Math!

This form helps us enter you into our accounting software.

PLEASE REGISTER WITH THE SAME NAME USED TO ORIGINALLY CONTACT US OR LET US KNOW IF A DIFFERENT NAME IS BEING USED.

After completing the form you will see a link to enter your PAYMENT INFORMATION into a new form that will simply charge your account $0.01 to allow us to save your payment information.

If you miss the payment form link you can head back to our Getting Started page and you will find it there.

You only need to fill each form ONE time even if you have more than one child receiving tutoring. Please fill in all fields.

If your credit card is declined in the future for any reason, we will just send you an invoice with a link to a simplified Payment Authorization Form. You won't need to fill in this google form again.

Current Tutoring Rates:
Minimum 1 hour sessions except for special arrangements.
Appointments are charged as time booked plus any additional time.
General Math, Science, and Language: 108/hr.
Calculus, Advanced, Honors, AP, IB: 118/hr.
Test Prep such as SAT, ACT, ISEE, SSAT: 138/hr
Mark’s and Gene’s rates available upon request.
Two or more students in same session from same family: 32.5% discount per student.
Two or more students in same session from different families: 25% discount per student.

Many Thank!
-f(M)
Email address *
First Name *
Last Name *
Cell Phone formatted as: ### ### #### *
Home Phone formatted as: ### ### ####
Mailing Address Line 1 *
Mailing Address Line 2 (for Apt. or Suite #)
City *
State formatted as: XX *
Zip Code formatted as ##### or #####-#### *
Student Name
Student School
Student High School Grad Year (2033 – “current grade”)
Submit
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