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Adult Learning Center | 4160 Virginia Beach Blvd.| Virginia Beach, VA 23452 | Office: (757) 648-6050 | Contact Us
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ADULT LEARNING CENTER - REGISTRATION FORM

How did you hear about our courses?     

Please use one registration form per student.   Please print clearly   Form may be duplicated.

SS#/Student Number   Birth Date        Male/Female    
Last Name    First   MI
Address
City      State      Zip
Phone (Day)      Eve Phone   
Cell Phone    E-Mail Address    
Senior Citizen (60yrs +) MasterCard       VISA  Check   Money Order
Credit Card No.           Exp. Date
Card Holder's Signature _________________________________________________________

 Course #    Course Title  Start Date

Start Time  

  Location 

 Fee
 
  
 
 
 

Please add $12.00 per course  if you  live outside Virginia Beach

TOTAL 

For Office Use Only

Receipt Number______________________                Amount Paid________________________

Check___     Credit Card ___      Cash ___      Money Order ___    Date___________________     

Initials________        Comment______________________________

Withdrawal/Transfer and Refund Policy

Your satisfaction is very important to us. Decisions to hold a course are based upon sufficient enrollment to underwrite the cost of instruction; therefore, you will receive a full refund if we must cancel a course due to low enrollment. NO REFUNDS will be issued once a course has started. If you must withdraw or transfer from a course or section, your WRITTEN request must be received FIVE BUSINESS DAYS BEFORE the class start date, or it will not be considered. Your refund, LESS a $15.00 processing fee, will be issued within two weeks.

Make checks payable and mail to:  Adult Learning Center, 4160 Virginia Beach Blvd., Virginia Beach, VA 23452,  Phone: 648-6050,  Fax: 306-0999

Your registration will be confirmed by mail.  If you do not receive a written confirmation at least 5 days prior to the first class, please call our office to verify your status.  
 



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Updated Wednesday, August 5, 2009