Skate Great USA Enrollment Form

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Skate Great USA School Of Skating(TM)
Student Enrollment Form [ CHECK CURRENT RATES ]
Please Complete Form And Return With The Required Payment To:
Debbie Merrill - PO Box 3452 - Santa Monica, CA 90408
Please Make Checks Payable To: DEBBIE MERRILL
Email: debbie@skategreatusa.com

LESSON TYPE

[ ] In-Line

[ ] Roller

[ ] Ice

[ ] Private

[ ] Group - Number of Students______

AGE GROUP

[ ] Adult

[ ] Teen

[ ] Child

SKILL LEVEL

[ ] Beginner

[ ] Intermediate

[ ] Advanced

YOUR INFORMATION

NAME:_______________________________ PHONE ________________

ADDRESS:___________________________________________________

CITY:_______________________________ STATE:____ ZIP:__________

TERMS: 24 HOUR NOTICE REQUIRED FOR CANCELLATION
LESSONS ARE TRANSFERABLE BUT NOT REFUNDABLE

SIGNATURE:_________________________________________________

PAYMENT INFORMATION

TOTAL AMOUNT ENCLOSED: $______________ DO NOT SEND CASH

[ ] Check

[ ] Money Order

[ ] Credit Card

Make Checks Payable To: Debbie Merrill

CREDIT CARD INFORMATION

[ ] Visa

[ ] MasterCard

[ ] AMX

NAME ON CREDIT CARD:_______________________________________________________

CARD NUMBER:___________________________________________

EXPIRATION DATE: (MM/DD/YY) __________________

CARDHOLDER SIGNATURE:_________________________________________________

Mail This Form, Along With Payment Or Credit Information To:
Skate Great USA
Debbie Merrill - PO Box 3452 - Santa Monica, CA 90408
Thank You For Choosing "Skate Great USA" (310) 821-5489