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REGISTRATION FORM

Language Institute of Atlanta

7000 Peachtree Dunwoody Road, NE

Building 16 - Suite 300

Atlanta, GA 30328

Tel: (770) 730-0000 / Fax: (877)733-0171

info@atlantalanguage.com

www.atlantalanguage.com

Language: ______________________________________       Level:  __________________________  

Day:          _______________________________________       Starts:  __________________________

Time:         _______________________________________       Ends: ___________________________

TUITION TOTAL:  $____________________

Book(s) are additional and can be purchased at registration. A representative will call you to confirm your registration 

at which time you can pay for your textbook.               

Name _______________________________________________________________________________________________

Cell Phone ______________________________________  Business Phone _______________________________________

Home Phone  ____________________________________  Fax:  ________________________________________________

Address_______________________________________________________________________________________________

City  _____________________________  State ____________ Zip code  ___________________ 

Email:_________________________________________________________________________________________________

How did you hear about our courses?___________________________________________________________________

REFUND POLICY

Due to our flexible schedules and our competitive prices, it is not possible to give you a refund after the date you register. Group classes may

not be canceled or rescheduled.

Twenty-four hour notice is required to reschedule or cancel a private or semi-private class, otherwise full payment of the class will be charged.

Classes canceled by the institute will be refunded.

If my check is returned my account may be electronically debited for the full face value and any applicable fees

I am aware of the institute policies and I am registering for the above classes

Credit Card number:___________________________________________   Amex   Visa    MC

Expiration date:  ____________  /  Verification code: _____________

Please make check payable to Language Institute of Atlanta, Inc.