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Forms and payments may be dropped off at any time during our office hours. Register in person, by mail, fax (212) 697-8379 or phone at (212) 697-8374. There is a $30 registration fee per student.
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*Name (last) (first)
Date of Birth / / (mm/dd/yy)
*Address Street Apt. #
City
State Zip Code
*Primary Phone
Cell Phone
Fax
E-mail
Company
*How did you hear about us?
Please select desired course(s)


Courses for Adults
Starting date: / / (mm/dd/yy)
Private lessons At Amity Language Institute
Off-site
 {Desired location: Home Office Other      Address:
Number of hours:
Student’s level:
Learning history:
Goals:
Semi-private lessons At Amity Language Institute
Off-site
 {Desired location: Home Office Other      Address:
Number of hours:
Student’s level:
Learning history:
Goals:

Courses for Young People
Starting date: / / (mm/dd/yy)
Private lessons/Tutoring At Amity Language Institute
Off-site
 {Desired location: Home Office Other      Address:
Number of hours:
Student’s grade:
Name of school:
Student’s level:
Learning history:
Goals:
Method of Payment Check or Money Order (made payable to Amity Language Institute).
Credit Card: MasterCard   Visa   JCB
Cash (at Registration Office only)
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