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____________________________________________________
Note: Credit card payments made in person or by phone only.
REFERRED BY__________________________________________________________
Make checks payable to LIFETIME LEARNING.
If you wish to have books mailed, please enclose an additional $10.00 for mailing and postage fees. Classes will be
held at LIFETIME LEARNING, 3259 E. Sunshine Street, Suite F, Springfield, Mo. 65804.
Student Questions
