CHINESE LANGUAGE CLASS REGISTRATION FORM (Adults)

Mencius Chinese Academy
Chinese Language Class Registration Form (Adults)
Wibesite: www.menciusacademy.org
Phone: 480-206-3469 Email: www.menciusacademy.org/contact

Student Information:

Name:_____________________________________________________________

Chinese Class Level/Location: ____________________________________________

Class Start Date:_________________ Class Start Time (please circle) 6 pm or 7:30 pm

E-Mail:_______________________________________________________________

Company _____________________________________________________________

Work Phone: ____________________ Cell phone: ___________________

Home Phone _______________________________________________

Payment Amount:______________

Please make check payable to: Mencius Chinese Academy
Please mail the check to: 8776 E. Shea Blvd. Suite B3A-538, Scottsdale, AZ 85260-6629