New Customer Registration Form
Thanks for registering with Fusion Math!

After completing the form you will see a link to enter your PAYMENT INFORMATION. You will be asked to enter your name and address again - we are sorry about this but the two systems are separate.

You only need to fill each form ONE time even if you have more than one child receiving tutoring but 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: 104/hr
Calculus, Advanced, Honors, AP, IB: 114/hr
Test Prep such as SAT, ACT, ISEE, SSAT: 134/hr

Many Thank!
-f(M)

Email address *
First Name *
Your answer
Last Name *
Your answer
Cell Phone formatted as: ### ### #### *
Your answer
Home Phone formatted as: ### ### ####
Your answer
Mailing Address Line 1 *
Your answer
Mailing Address Line 2 (for Apt. or Suite #)
Your answer
City *
Your answer
State formatted as: XX *
Your answer
Zip Code formatted as ##### or #####-#### *
Your answer
OPTIONAL: SAT Class Registration:
Student Name
Your answer
Student School
Your answer
Student Grade
Your answer
Submit
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