Pacific AP Institute - Registration Form

PACIFIC AP* INSTITUTE

Registration Form For

Notre Dame de Namur University, Belmont, California

June 22 through June 25, 2009

Name _______________________________________________ Female _______ Male _______

Address ______________________________________________________________________

City __________________________________________ State _______ Zip ________________

E-mail Address ___________________________________

Home Phone (_____) ___________________ School Phone (_____) ___________________

School _______________________________________________________________________

School Address ________________________________________________________________

City __________________________________________ State ________ Zip _______________

AP Subject Session ___________________________ New to this AP Subject? Yes ____ No ____

TUITION

Early Registration - payment must be received on or before March 28th
$650 __________

Tuition after March 28th through May 30th registration deadline
$700 __________

Lab fee for Biology & Environmental Science
$50 __________

Late fee after May 30th registration deadline
$50 __________

ON CAMPUS HOUSING/MEALS

Private room in quad suite, bathroom shared with 3 others, 3 meals/day
$300 __________

Private room in quad suite, semi private bathroom, 3 meals/day
$425 __________

TOTAL PAYMENT ENCLOSED:
$ _____________

Method of Payment (NO PURCHASE ORDERS)

____ Check enclosed payable to PACIFIC AP INSTITUTE

Credit Card: MasterCard _____ Visa _____

Card # ___________________________________________ Exp. Date: _______________

Print Name On Card __________________________________________________________

Signature __________________________________________________________________

Print out this form, complete it and mail with payment to:

PACIFIC AP INSTITUTE

PO BOX 2352

MANHATTAN BEACH, CA 90267-2352

Or FAX to: (310) 546-7152

Faxed forms must include credit card information. A confirming FAX wil be sent within 48 hours

Return to: PAPI HOME NOTRE DAME HOME COSTS ON CAMPUS HOUSING OFF CAMPUS HOUSING

TUITION
Early Registration - payment must be received on or before March 28th	$650 __________
Tuition after March 28th through May 30th registration deadline	$700 __________
Lab fee for Biology & Environmental Science	$50 __________
Late fee after May 30th registration deadline	$50 __________
ON CAMPUS HOUSING/MEALS
Private room in quad suite, bathroom shared with 3 others, 3 meals/day	$300 __________
Private room in quad suite, semi private bathroom, 3 meals/day	$425 __________
TOTAL PAYMENT ENCLOSED:	$ _____________