Winning in Math Registration Form Please provide the following contact information: Today's Date: * Student's Name: * Parent's Names: * Street Address * Address (cont.) City * State/Province * Zip/Postal Code * Parent(s) Work Phone * Home Phone * E-mail * School Attending: * Grade: Student's Academic Strengths: * Student's Academic Weaknesses: * Does the student have any learning differences about which we should be aware? Yes No If so, please explain: Workshop date for which student is registering: How did you hear about Total Learning Concepts?: * Workshop Fee: $225 (1/2 off for students on a regular math tutorial schedule) Workshop Length: 4 hours $65 New Student Enrollment Fee $35 Returning Student Fee To hold a seat in our course, a $50 deposit is required, plus new student enrollment or returning fee, if applicable. RESET
