Online Enrollment Agreement <Japanese Course>

First Name
Middle Initial
Last Name
Gender Male Female
Nationality
Street Address
City
State
Country
Zip Code
Home Phone number
Date of Birth (mm/dd/yyyy)
Email *

Registration

 
Wks
Hours
Original
Tuition
Discount
rate
Discount tuition fee untill the end of campaign
Registration
fee
Tuition fee
Total
Beginner
6
21
$415
$100 OFF
$30
$285
$315
Beginner
9
31.5
$575
$30
$445
$475
Beginner
12
42
$720
$30
$590
$620
Intermediate
12
42
$720
$30
$590
$620

Start Date;

Payment method
Check (Payable to PCTECH)
Cash
Visa
Master
Amex
Payment by wire transfer from foreign bank account
Google secure server-online payment

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By my signature, I agree to the Cancellation and Refund policy.
Student signature 


Professional language school in New York for English (ESL) and Japanese study. Learn at PC TECH - offering language and computer training courses in NYC.