American English Express Registration Form __ Yes, I want to jump on the American English Express! PLEASE PRINT THIS FORM AND MAIL TO: English 4 All, Inc. PO Box 1589 Southampton, PA 18966-1589 or call (914) 714-2709 for a personal interview! First Name_________________________________________ Last Name _________________________________________ Street Address __________________________________________ City _________ State ____ Zip _______ Phone number __________ Please indicate your 3 choices from the course schedule: Choice 1: Course number ______ Choice 2: Course number ______ Choice 3: Course number __________ COST: ________________ payment type: Cash ___ Credit Card: Type: Visa ____ MC ____ Credit Card Number ________________ Expiration Date: ________ Signature _________________________ Date ________________