Please print and fill out this form and mail with your check. Register each student on a separate form.

Student's Name__________________________________________________________

Parents' Name __________________________________________________________

Student's Date of Birth ____________________________________________________

Street Address __________________________________________________________

City, State, Zip code ______________________________________________________

Phone Number __________________________________________________________

E-mail Address __________________________________________________________

How did you hear about Cassiodorus.org Online Classes?___________________________

Please circle the subject and session you are registering for. All tutorials are $200 per course/semester. You may register with a $50.00 deposit per tutorial, and the remainder is due before August 1. All times are Pacific Standard Time.

TOTAL AMOUNT ENCLOSED__________________________________

Fees do not include books. Make checks payable to Peter Roise and mail to Cassiodorus.org, 617 Homestead Plc, Moscow, ID 83843.