Step 1: Choose your Session Type

The Thirty $50 To Reserve An Appointment
The Sixty $75 To Reserve An Appointment
Senior Choice $100 To Reserve An Appointment

Step 2: Fill out your reservation information
Full Name:
Mailing Address:
City:
State:
 		Zip Code:
Home Phone Number:
Cell Phone Number:
My e-mail address is:
Verify e-mail address:
School You Attend:
Comments/Questions:

Appointment Information
Month
(1ST Choice)
Month
(2ND Choice)
Day of Week
(1ST Choice)
Day of Week
(2nd Choice)
Preferred Time
Confirmation

Payment Type: By Mail

Upon submission of this form by clicking the button below, you MUST make a payment by mail within 5 days of today. Failure to do so will result in a loss of your reservation.

 
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