PRINT this form

StepAhead Educational Consultants

Suite 106-425
670 Auburn-Folsom Road
Auburn CA 95603
(916) 626-4415

Web site: http://yourstepahead.com
Email: info@yourstepahead.com

Please Print
Student
Parent
Name - First  Last
                   (underline)
    
School / Grade
   
Special Needs?
    
Address, City, St Zip
  
Phone: Day
  
Phone: Evening
  
Email
  
Please register me/us for the following:
   class_____________ location____________________
Starting date:
  
How did you hear about this class?
 Counselor Teacher
Flier Newspaper Friend Other _____
Use the back of this form to include any information that you feel might be useful to the instructor for the purpose of this class.
 See comments on back of form.
Mail with a check payable to: StepAhead Educational Consultants • 670 Auburn-Folsom Road • Suite 106-425 • Auburn • CA • 95603 A letter/email will be returned to you confirming your reservation.