CLICK HERE FOR A .pdf  FILE OF THIS CONTRACT

VDT ACADEMY© PUBLIC WEB LIVE BROADCAST CONTRACT
Mailing address:    VDT Academy, P.O. Box 1663, Bellflower, CA90707
Tel. (562) 920-0472 – FAX TO (562) 920-1827 

WEB-BROADCAST SERAK® LESSONS -- PRINT OR TYPE: 

Last Name: ___________________________ First: ___________________ M.I. ______

Address: ____________________________________________ Apt/Bldg/Ste.___________

City: _______________________________State ____________   Zip :_____________

Date of Birth_______________ Town_________________State _____  Country __________

Drivers License:   State ________ No. ___________________

Military ID# Rank ____________________ Branch: ____________ DOE _______________

Phone:  _________________________ Work Phone:  __________________________

Mobile: _________________________   FAX #:  ______________________________

**EMAIL address (REQUIRED): ______________________________________________

CHOOSE your Web Broadcast Tuition:

1.)  $35 per month to view unlimited broadcast classes per week, __________  (Annual 12-month contract*)
*The above program includes a 12-MONTH Program contractual commitment requirement.

2.)  $45 per month to view unlimited broadcast classes per week,   __________  (4 [four]-month contract**)
**The above programs include a 4-MONTH Program contractual commitment requirement.

3.)  $60 for ONE month to view unlimited broadcast classes per week,   __________  Trial period, ONE month ONLY.

After you have completed this application and sent it to VDT Academy with the proper tuition, you will receive your complete Log-In information, along with class times and dates and instructions on how to connect via E-mail.  All notifications and updates regarding classes will be done via E-mail. 

FAX your Application to (562) 920-1827, and MAIL it to the VDT Academy P.O. address above.

Or you may cut and past this form into an E-mail in PDF format with an electronic signature, and send the application back to:    VDTAcademy@aol.com

FAX your Application to (562) 920-1827, and MAIL it to the VDT Academy address above. Or you can cut and past this form into an E-mail with an electronic signature (pdf), and send the application back to:    VDTAcademy@aol.com    
Either way, we still do need a hard copy with your signature on file.

I understand and have read and agree to the WEB BROADCAST Program 12- or 4- Month Contractual commitment chosen above;
I am paying the monthly Tuition commitment month to month by Automatic Credit Card withdrawal.  I am including my credit/debit card information below:

 Please choose your credit card type:
 By Credit/Debit card Only - US mainland and International

 Visa____ MC____ AMEX____ Discover____

Name on Card ___________________________________________________

Card Number _____________________________________  Exp. Date_______

Signature  __________________________________________________________ 

Date:   Month _______________ Day _______Year___________

BILLING Address (IF different from above):

__________________________________________________________________________

__________________________________________________________________________

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Office Use Only:
Accepted: Yes ___ No ___ Date: _____________        Student ID: # ______________________