____________________________Last Name _______________________First Name
______________________Address _________________City _____State
_______Zip
____________________Phone Number _______________________________E-Mail
Grade(s) you teach________ District Name__________________School Name________________
Have you previously taken a course from Learner's Edge Inc.? Yes or No (circle)
New address? Yes or No (circle)
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CIRCLE the courses and credits you would like to register for: |
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Course |
Credit Price |
Institution |
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A letter of confirmation will
be sent upon receipt of registration.
A $30 cancellation fee will apply for all on-site courses cancelled within 30 days of course start date.
Total for All Courses: __________________
Charge my VISA / MC / Discover: __________
- __________ - __________ - __________ Exp._____-_____
Paid with Check #: _______________
Signature:
________________________________________________
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