CM Live! Middle Ages Literature: Registration Form
Please use this form to register your child(ren) for the CM Live! Middle Ages Literature Course (2012-13). Upon receipt of this registration form, a Paypal Invoice will be sent to you for the Registration Fee ($30). This fee is per student, and non-refundable. Payment of the Registration Fee will reserve your child(ren)'s seat in this class.  The Tuition Fee (less $30) will be due in two payments, the first due on Sept 1 ($45), and the second on Oct 1 ($45). You will be invoiced via Paypal for these remaining payments, unless indicated otherwise. (Please note below if you'd like to be billed for the full tuition up front or if you otherwise need to discuss payment options.)  

Feel free to contact us via the CM Live! website, if you have any questions: http://sond97.wix.com/cmlive#!form__map/c24vq.
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Parent/Guardian's Full Name *
Parent/Guardian's Email Address *
Student #1: Name *
Student #1: Email Address
Required if they plan to use this address to enroll in the course. Each student requires a unique email address in order to enroll.
Student #1: Birth Month/Year *
Student #1: Male or Female? *
Student #2: Name
Student #2: Email Address
Required if they plan to use this address to enroll in the course. Each student requires a unique email address in order to enroll.
Student #2: Birth Month/Year
Student #2: Male or Female?
Name for Paypal Account
Please contact us for payment options if you are unable to pay via Paypal.
Email Address for Paypal Invoicing
Please contact us for payment options if you are unable to pay via Paypal.
Parent's Phone Number
While our primary mode of communication will be by email, please leave a number where you can be reached, in lieu of email.
Parent's Cell Number (optional)
While our primary mode of communication will be by email, please leave a number where you can be reached, in lieu of email.
State/Country of Residence *
At this time we can accept payment in US Dollars only. Please contact us if you are unable to pay in US Dollars.
In what Time Zone do you live?
Our course start/end time details are displayed in CST time. Please adjust accordingly for your time zone.
How did you hear about us?
We like to say thank you to our referrals!
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