Regus University
Enrollment Form

Regus University

You may print this form, complete it, and fax it.  Or, you may copy and paste it into your email, complete it, and email it.  Or, you may simply provide answers to the questions from the form in your email and send.

Enrollment Must Be Received By August 31, 2010 for New Members
to Receive the $3,000 Tuition Scholarship Grant!

Payment is by Debit, Credit Card or Electronic Check Only!

You may enroll by Phone 202-379-2840, Fax 416-352-5142, or Email

(If you enroll by email, simply provide the information requested
below in your email)


If you have questions, please contact us at 202-379-2840

Name_____________________________________________

Program/Degree/Selection: ___________________________

Mailing Address:_____________________________________

Email Address:______________________________________

Phone Number:  _____________________________________

Fax Number:________________________________________

Occupation:  ________________________________________

Prior Education/Degrees/Certifications___________________

__________________________________________________

Payment Information for $98 Annual Membership Fee & Tuition:
Payment is by Credit Card, Debit Card, or Automatic
Checking Account Withdrawal ONLY

Name on Card:  ______________________________________

Address of Card Holder:_______________________________

Credit or Debit Card Number____________________________

Expiration Date on Card_______________________________

Three Digit Number from Back of Card:____________________
Or

Name on Checking Account:  ___________________________

Bank Routing Number From Check: ______________________

Bank Account Number:  _______________________________

I authorize payment of $98 annually for membership in Regus University and The American Colleges.  Please initial here  _____

I authorize Regus University and The American Colleges to charge

my credit card, debit card or my checking account for the payment

method checked below.  Please initial here  _________

Please initial the line which represents your selection of payment plan

A.  Discounted tuition after $3,000 Tuition Scholarship:         

Bachelor =  $2,995    ____
Master    =   $3,195    ____
Doctoral  =  $3,895    ____

B.  Payment plans are available by special arrangement
                               
C.  Membership Fee of $98 is in addition to tuition.

Cancellation Policy

1.  The annual membership fee of $98 is nonrefundable.

2.  If the member requests cancellation within the first 3 days after enrollment, a 100% refund shall be made, excepting the first annual membership fee.  After 3 days there is no refund.

3.  Once the Orientation Information has been released to the student, there is no refund, even if the student cancels within three days.

I agree with all of the above terms and conditions.  Please enroll me as a member of the American Colleges.

__________________________       Date:  _______________

               Sign Your Name

Contact Us

This is not a public location 
We do not accept mail at this location 
Correspondence is by email or fax only

601 Pennsylvania Avenue
Wash, DC 20004

202-379-2840 Phone
416-352-5142 Fax

www.regusu.org