Institute for German Language

Registration Form

NAME:_________________________________________________________________

ADDRESS:______________________________________________________________

CITY:___________________________STATE:_______

ZIP:____________________

HOME PHONE:__________________

BUSINESS PHONE:____________________

COURSE:________________DAY:________________TERM:___________________

ALTERNATE COURSE:__________________________________________________

HOW DID YOU HEAR ABOUT US? PLEASE CHECK:
_ FRIENDS
_ GERMAN SCHOOL
_ NEWSPAPER
_ PROGRAM IN THE MAIL
_ WEBSITE

AMOUNT DUE FOR TUITION:___________________________________________

AMOUNT DUE FOR BOOKS:_____________________________________________

RECEIPT

AMOUNT PAID FOR TUITION:___________________________________________

AMOUNT PAID FOR BOOKS:___________________________________________

DATE:
TEACHER’S SIGNATURE

Print out the Form and mail it to:

Christl Mageras, Director
26 Garretson Road
White Plains
NY 10604

Send a check along with your form and you will receive a receipt at the first session. Home Schedules