Free Demonstration Webinar Registration Form
Free Webinar information will be sent via email. Register and attend the webinar to get a $10 discount!
Student's Name
*
First Name
Last Name
Grade
2
3
4
5
6
7
8
9
Student School
*
Parent's Name
*
First Name
Last Name
Parent's E-mail
*
Parent Phone Number
*
-
Area Code
Phone Number
How did you hear about us?
*
Email Group (Please provide name of group)
Returning Student
Referred by a Friend (Please name the friend)
Information from an Event (Please name the event)
Physical Flyer (Please state where flyer was received)
Online Advertisement (Craigslist, NextDoor, etc; Please specify)
FaceBook
Other (Please specify)
Please expand on how you heard about us.
*
Location:
Dublin
Beaverton
Mountain House
Cupertino
Pleasanton
Cumming
Johns Creek
Henderson
North Wales
Hopkinton
Plano
Frisco
Carrollton
Fremont
Ashburn
Acton
San Jose
Vienna
Reno
Foster City
San Ramon
We are asking for your help in order to promote our program. We would like you to like our facebook page and send this information to at least 2 of your social groups. We appreciate your support. Benefits include referral discounts and more!
I will like the Shooting Stars FaceBook page today! (https://www.facebook.com/academicbootcamps/)
*
Yes
No
Name two social groups you will forward this free demonstration session information to!
#1:
*
#2:
*
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