Student’s Agreement

Fields marked with an asterisk * are required.
Personal Information  
*First Name:
Middle Name:
*Last Name:
*Age:
*Gender:
Female Male
*Marital Status:
Single Divorced Married Separated Widowed
*Race:
*Email:
*Mailing Address::
*City:
*State:
*Zip Code:
*Home Phone::
Work Phone::
Cell Phone::
Employer:
Position:
Class Information  
*Class:
Class Location:
Tuition to Pay:
Your Feedback  
Where did you hear about this Program:
State newspaper Free Times USC Job Fair
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Please tell us why you are interested in this program (optional):
Terms of Service  
 

I understand that I will participate in the Chinese Culture Center programs and activities at my own risk. I give consent to Chinese Culture Center to use my name, photos, videos and any other forms of media to promote and publicize the classes and activities. I’ll be punctual for the classes. I understand that no refunds will be issued.

 

By clicking "Submit" you agree and consent to the Terms of Service above.