PALP Registration Form

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Wise Education looks forward to offering online registration for your convenience. We plan to have this option available very soon. Until then, we appreciate your patience and your business. We request that you print the form from Pennsylvania License Prep, fill it out, and send it to Wise Education Inc. by fax or mail. Thank you.

First Name
Middle Initial
Last Name	Jr. Sr. III
Date of Birth
Soc. Sec. #
Home Address
City
State
Zip
Home Phone
Bus Name
Bus Phone
Bus Fax
Bus Address
City
State
Zip
E-mail

I would like to register for the following class(es):

January 24, 25, 26	BENSALEM	Courtyard Marriott	Mon. - Wed.
March 14, 15, 16	HORSHAM	Days Inn	Mon. - Wed.
May 23, 24, 25	BENSALEM	Courtyard Marriott	Mon. - Wed.
July 18, 19, 20	HORSHAM	Days Inn	Mon. - Wed.
September 12, 13, 14	BENSALEM	Courtyard Marriott	Mon. - Wed.
December 5, 6, 7	HORSHAM	Days Inn	Mon. - Wed.

Please select one from the options below:

	Class Only	$ 295
	Class & CD-Rom	$ 345

Please select payment method:

	VISA	#	Exp.
	MASTERCARD	#	Exp.
	DISCOVER	#	Exp.
Cardholder's Name:

Print copy of this registration form and send with payment to:

WISE EDUCATION
1501 Cobblestone Court
Thorofare, NJ 08086
Fax: 856-384-8414

Wise Education: 800-577-9888
wise.education@verizon.net

PENNSYLVANIA LICENSE PREP