Student Registration Form
* Denotes required fields
 
Course Information
Please Select Your Courses:
Student Packages:
Package Amount
(First 4 Unit Levels)
$100.00 USD
(Units 1-12)
$200.00 USD
$50.00 per year to renew
 
Student Information Viewable
If You Would Like To Make Some Of Your Personal Information Available To Other Students Please Check The Appropriate Boxes In The Far Right 'Viewable' Column
*First Name
*Last Name
*Nick
Choose a name/nickname to use in the Student Lounge. It will be what you are known by in the studio
 
*Address1
Address2  
*City/Town
*Province/State
International  
*Postal/Zip Code
*Country
*Home Phone
Fax
*Email
Embroidery Equipment Used
Digitizing/Editing Software Used
*Desired Username  
*Desired Password  
*Confirm Password  
If You Were Reffered By Someone From This School Please Enter Their Student Number
Referred By  
 
Business Information Viewable
Company Name
Address1
Address2  
City/Town
Province/State
International  
Postal/Zip Code
Country
Business Phone
Fax
Email
Payment Method
Basic 1 Year Tuition: $100 USD
Advanced 1 Year Tuition: $200 USD
 
Type
Name On Card
Number
(no spaces)
ExpiresMonth Year 
Token Number
(no spaces)

LEGAL NOTICE AND RELEASE

I have read and agree with the
LEGAL NOTICE AND RELEASE &
TERMS OF USE FOR STUDENT LOUNGE FORUM