First Name *Last Name *Email Address *Confirm Email Address *Phone *Gender *BoyGirlAge *Lesson Days *Mondays & WednesdaysTuesdays & ThursdaysPreferred Time *Preferred Time9:00AM – 9:30AM9:30AM – 10:00AM10:00AM – 10:30AM10:30AM – 11:00AM11:00AM – 11:30AM11:30AM – 12:00PM3:00PM – 3:30PM3:30PM – 4:00PM4:00PM – 4:30PM4:30PM – 5:00PM5:00PM – 5:30PM5:30PM – 6:00PM6:00PM – 6:30PM6:30PM – 7:00PMStart Date (Mon & Wed Only) *Start Date (Tue & Thu Only) *About Tentative Time *I understand the selected preferred time is TENTATIVE and the academy may reschedule if the time slot is full (max 4 students). I agree to be contacted via email/phone to confirm or adjust my time.Total US$Your Information Name: {name-1-first-name} {name-1-last-name} Email: {email-1} Phone: {phone-1} Gender: {radio-2} Age: {number-1} Student Type: {radio-1} Package: {hidden-4} Lesson Days: {radio-3} Start Date: {date-1}{date-2} Preferred Time (tentative): {select-1}Order Summary PROMOTION: 24 Lessons (2/weekly × 12 weeks)$600.00Order Total: ${calculation-1}*Includes Registration and UniformOrder TotalCredit / Debit Card *Place Order