AYA Fall 2014 Weekend Academy Registration Form

Please sign up. Tell us the courses you would like; Then click to PAY. A registration packet will be emailed to you with more details to get you started. Call 404.292-9002 or 404.201.2356 if you have questions, need help, or need a custom registration.

Adult Student Name Adult Student Name First Last
Youth student Name Youth student Name First Last
Representing Parent or Guardian Representing Parent or Guardian First Last
2nd Representing Parent or Guardian 2nd Representing Parent or Guardian First Last
Date Date / MM / DD YYYY
Phone Phone - ### - ### ####
Alternate Phone Alternate Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Alternate Email
If enrolling a youth, what type school does (or has) your child attend/ed?

If enrolling a youth, what type school does (or has) your child attend/ed? public private parochial charter home school Other
Adults, if you could change one thing about your present or former education, what would you change?
If you could change one thing about your child's present or former schooling, what would you change?
What would you like to see you, your child, and your family get as a result of participating in AYA's Weekend Academy?
Course Selection

Choose Courses. Check multiple courses if you choose to.
Choose your courses. All courses are discounted for a limited time to $89.00 each.

Choose your courses. All courses are discounted for a limited time to $89.00 each. Following Araminta Blues and Bad-Talking Storytellin' Morning Math Tutorial Clinic Morning Reading Tutorial Clinic Morning Writing Tutorial Clinic Haiti From the Bottom Image-A-Nation Photography I Image-A-Nation Photography II Writing About Literature Afternoon Math Tutorial Clinic Afternoon Reading Tutorial Clinic Afternoon Writing Tutorial Clinic Ready For The Week Where My Voice Begins Critical Thinking
Order the Critical Thinking - When It's Not Smart To Be Smart - DVD

Order the Critical Thinking - When It's Not Smart To Be Smart - DVD Yes, send me 1 copy of the Critical Thinking DVD ($25.00) Yes, send me 3 copies of the Critical Thinking DVD ($70.00) Yes, send me 6 copies of the Critical Thinking DVD ($115)
Let Your Motto Be Resistance: We Will Shoot Back & Blood In The Basement. Special Community Partnership Course - Pay via 10-10-50; otherwise $99.00

Let Your Motto Be Resistance: We Will Shoot Back & Blood In The Basement. Special Community Partnership Course - Pay via 10-10-50; otherwise $99.00 Will sign up for 10-10-50 (starting with a $10 payment now) Will pay full tuition $99.00 and skip 10-10-50 Other Other
Private tutoring 1 hour sessions by appointment. Face-to-face or via our Skype-like platform.

Private tutoring 1 hour sessions by appointment. Face-to-face or via our Skype-like platform. Tutorial Assessment $49.00 per subject 1 Hour Private Tutoring (by app) $39.00 3 -1 Hour Tutoring Sessions $99.00 6 - 1 Hour Tutoring Sessions $174.00
You've just completed the Payment By Credit or Debit Card Section.

Based on your choices above, your payment will be totaled. Once you submit this form, you'll be taken to PayPal to pay by credit, debit card or your PayPal account. Note: You DO NOT have to have a PayPal account. Just click on the "Don't have a PayPal Account" link. We'll check your registration against your payment amount. If there is a discrepancy, we'll contact you to resolve it. If you've signed up for the Family Plan ($249) or the 10-10-50 option ($10) you are paying for the first month. We'll contact you to arrange a payment subscription for the remaining months.
If you are paying by check, money order or cash, uncheck the courses above, and type their names here instead.
If you are paying by check, money order or cash, choose the number of courses that correspond to your check or money order or cash amount, make check or money order for this total amount payable to AYA Educational Institute and mail to: 852 Brafferton Place, Stone MT, GA 30083. Bring cash to the address just listed above.

If you are paying by check, money order or cash, choose the number of courses that correspond to your check or money order or cash amount, make check or money order for this total amount payable to AYA Educational Institute and mail to: 852 Brafferton Place, Stone MT, GA 30083. Bring cash to the address just listed above. 1 Course ($149) Discounted to ($99) 2 Courses ($298) Discounted to ($108) 3 Courses ($447) Discounted to ($297) 4 Courses ($596) Discounted to ($396) Family Plan ($249.00) Per month multiple courses Collegiate Complement Advisory: $279.00 Institutional Rate (Call Administrator): 404-532-9958
If you have another preferred form of payment, check below.

If you have another preferred form of payment, check below. Online by subscription on a certain day of each month Cash in the AYA Office Money order through the mail Check in the AYA Office Check though the mail

Note that our preferred method is via subscription, and you may be asked to pay in this form if payments tend to run late via other methods.
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AYA Fall 2014 Weekend Academy Registration Form

AYA Fall 2014 Weekend Academy Registration Form

Course Selection

You've just completed the Payment By Credit or Debit Card Section.

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