Rice Reading Program REGISTRATION FORM

RICE READING PROGRAM - REGISTRATION FORM

* Indicates required field

PayPal receipt number *

Name of student *

First

Last

Age of student *

Phone Number *

Select One *

Parent or guardian name *

First

Last

*Parent/guardian or student email *

*If student is under 18, parent or guardian email is required.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Secondary email (optional) *

Additional phone number (optional) *

Select One *

Optional Payment Plans *

Plan A - $500.00 (20 Weeks) Plan B - $400.00 (16 Weeks) Plan C - $300.00 (12 Weeks)

➵ Only monthly payments are accepted for all plans.
⇨ NO REFUNDS AFTER 30 DAYS FOR ANY PLAN CHOSEN . (Also Non-refundable registration fee)

Any questions or comments *

Submit