Live Online Course Registration Form


Instructions: Fill out this form and press the "Submit" button to send the completed form to Lentz & Lentz SAT Prep.

* = Required Information

* Student's Last Name:


* Student's First Name:


* Address:


* City/Town:


* State:


* Zip Code:


* Home Phone (w/ area code):


* Student Cell Phone (w/ area code):


* Email:


* High School:


Current Grade:

I am a Returning Student:

Student's Current G.P.A.:

Previous PSAT Scores (if applicable):

Critical Reading:   Writing Skills:   Mathematics:

 

Previous SAT Scores (if applicable):

Critical Reading:   Writing Skills:   Mathematics:

 

Credit Card Information
* Credit Card Type:


* Credit Card Number:


* Name on Card:


* Expiration Date:



* Credit Card Verification Code (last 3 digits on the back of your card):


* Guarantees and Conditions:
Please read the following paragraph carefully. You must check the I Agree box or your registration will not be considered valid.


I Agree

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