DISTANCE LEARNING PROGRAM APPLICATION FORM

Name Of Course__________________________________

Date:______________________

Name: ___________________________________________

Course Materials Should Be Shipped To The Following Street Address (Not P.O. Box):



Address: _____________________________________________________________________________

City State Zip: ________________________________________________________________________

Telephone:___________________________

E-Mail Address: ______________________

I have read and understand the course description and refund policy. I know that upon receipt of equipment, books, and materials, I am responsibile for payment of those items upon breaking the inner seal of the package.

_________________________________
Signature Of Applicant

Charge My Credit Card: VISA MasterCard (circle one) Amount Total: __________

Cardholder Name (please print)______________________________________________
Authorized Signature________________________________
Card #___________________________ Expiration Date______________
Please Make Cashier’s Check or Money Order Payable To The Andrews School. Payment By Personal Check Will Result In A Two-Week Delay In Shipment.

If you are paying by credit card, call our student coordinator with your enrollment information at (405) 721-3560. If you are paying by check, please mail it with your enrollment form to :

The Andrews School
5601 NW 72nd #167
Oklahoma City, OK 73132


E-mail: Linda@andrewsschool.com