Please be sure to review our Class Rates and Policies

Which type of Class would you like to register for?

Adult   Child

Student's Name:

First Last

Student's Date of Birth (If registration is for a Child):

Month: January February March April May June July August September October November December   Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year:

Parent's Name (If registration is for a Child):

First Last

Lesson/Workshop Title
See this page for our currently offered classes:
http://www.lapiazzadicarolina.com/new-schedule.htm

Title:

Day of the Week and Time:

Day Monday Tuesday Wednesday Thursday Friday Saturday   Time

Student's previous experience with Italian:

Student's Address:

Street:

City:  

State:

Zip:

Phone:

Home:

Cell:

Email Address:

Referred by:

Advertisement:   Web Site:   Friend/Relative:   Re-enrollment:

Tuition/Fee Due:

The Ammount Due is the cost of the Class plus Annual Registration Fee of $25. If you have already paid the annual registration fee for a year, you need only pay for the class.

Amount Due:

Method of Payment:

I am ready to pay online now with Paypal:

I will send a check:

The next screen will direct you to Paypal for payment OR will give you mailing instructions depending on your choice.