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.
(*required)
*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
Choose one
Beginning Level
Low Intermediate Level
Intermediate Level
Advanced Level
Preparation for JLPT
Corporate Lessons
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
Choose one
Group Lessons
Choose one
391
392
393
394
395
396
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)
© 2007 Amity Language Institute. All rights reserved.
