REGISTRATION  FORM        Return To Home Page
Please Print This Form, Fill It Out & Mail With Payment
Begin By Selecting a License Exam Answers Class Date Below

    ALL CLASS SEATS FULL or Call About Standby Seats CALL
For Other Class Dates
     [  ] Journey Test        [  ] Master Test         [  ] Other  

Today's Date   _________________________    201 ___  
Name __________________________________________________________
Address __________________________________________________________
City ____________________________ State  _______ Zip _____________
Home Ph (         )  ______   ___________ Work Ph   (         )  ______   _________
E-mail * ______________________________________________________
*   E-MAIL ADDRESS FOR A QUICK E-MAIL REGISTRATION CONFIRMATION   *  
CLASS  COST:   $379 
Pay Method:   [    ]  Check        [    ]  Money Order          Click here for UAW Voucher Info
REFUND POLICY If written notice regarding class non-attendance is received by us at least 10 (ten) days prior to class, the student may receive a full registration refund or class re-scheduling.
Non-Disclose Conditions:     All class material and information is proprietary and private.  Student agrees not to copy, disclose or transfer in any form for any reason any of the class material or information.
S
ignature:   Student certifies the information provided above is true, correct and agrees to the above refund policy and conditions.

STUDENT SIGNATURE *  _____________________________________  Date  _____________
                                            * *  Signature Required  * *


Print This Form & Mail To - - >
Checks Payable To:  CHUCK  COSSIN
(248) 347 - 9000
  CHUCK  COSSIN
PO  BOX  32
NORTHVILLE  MI  48167 - 0032

LOCATION  -  Comfort Inn of Plymouth Michigan    (734) 455 - 8100
Be Sure To Ask for The Chuck Cossin Discounted Student Room Rate
Easy To Find  ( I-275 @ Ann Arbor Rd - Exit 28 )   Friendly & Free Parking.
You Will Be Sent By E-Mail:  A Map To The Class & Other Helpful Class Information.