Please choose a class time.      3 to 5 p.m.        7 to 9 p.m.

Name:* 

Date of Birth:*    Students must be at least 14 years 8 months old to begin Segment 1

Address:* 

City:*     MI,   Zip Code:* 

Phone:*     2^nd  Phone: 

Email: 

How did you hear about us?: 

Cost: $285.00 (Full payment is due on the first day of class.) We accept Cash, Check, Money Order, Visa or MasterCard. (checks returned for any reason will be assessed a $25.00 fee.)

Required *