JASWDC - Acceptiva

Looks like you're using Safari! To complete your transaction you'll need to open the form in a new tab. Click the button below to continue.

This Form is in Test Mode

This form is not ready to process live transactions.

YOUR TRANSACTION DATA WILL NOT BE SAVED.

*** If you feel you are getting this message in error, please check
with the administrator of the site that sent you to this form. ***

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for The Japan-America Society of Washington DC’s (JASWDC) English Language School Fall Semester 2019.

Tuition for JASWDC Members

Qty

Description

Amount

Total

Tuition for JASWDC Members - Conversation Class

$200.00

---

Tuition for JASWDC Members – Individual Class

$27.50

---

Tuition for non-JASWDC Members

Qty

Description

Amount

Total

Tuition for Non-JASWDC Members - Conversation Class

$275.00

---

Tuition for Non-JASWDC Members – Individual Class

$32.50

---

JASWDC Membership Levels

(You may apply for membership at the same time you register for classes. However, membership is not required for registering for classes.)

Qty

Description

Amount

Total

Ume

$60.00

---

Tsutsuji

$250.00

---

Kiku

$1,500.00

---

Student

$40.00

---

(This membership is for students who are 23 years old and under. JASWDC
will ask you to provide a copy of your ID)

Total: $0.00

Salutation:

First Name: *

Last Name: *

Additional Name:

(Only for Family & Sustaining Memberships)

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Home phone:

Cell phone:

Home fax:

E-mail: *

A receipt will be e-mailed to this address.

Additional E-mail:

(Only for Family & Sustaining Memberships)

English Language School:

How did you learn about JASWDC’s English Language School?

How long have you lived in the United States?

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *