To Sign up for class please copy, fill in the following form, and return it to Lifetime Learning at 3259 E Sunshine Suite F, Springfield Mo. 65804. Students may also enroll by faxing information to 417-887-2622.  To sign up over the phone please call 417-887-2221 or 1-800-383-3365.  All enrollments for Pre-licensure education must be accompanied with a $75.00 non-refundable deposit. 

FIRST NAME___________________________________________________________

MIDDLE NAME OR INITIAL_______________________________________________

LAST NAME____________________________________________________________

ADDRESS_____________________________________________________________

CITY_________________________________________________________________

STATE________________________________ZIP_____________________________

DAYTIME PHONE (OR CELL)_____________________________________________

SOCIAL SECURITY NUMBER______________________________________________

COURSE______________________________________________________________

DATE COURSE BEGINS_________________________________________________

AMOUNT ENCLOSED____________________________________________________

PAID BY CHECK________VISA________M/C_______DISCOVER________________

CREDIT CARD # ______________________________EXPIRES__________________

NAME ON CREDIT CARD (SIGNATURE)_____________________________________

REFERRED BY__________________________________________________________

Make checks payable to LIFETIME LEARNING.  If you wish to have books mailed, please enclose an additional $4.00 for mailing and postage fees.  Classes will be held at LIFETIME LEARNING, 3259 E. Sunshine Street, Suite F, Springfield, Mo. 65804.