BY PHONE:
631-757-2700

BY MAIL:
Print registration form below and send with your
registration fee to: P.O. Box 254, Northport, NY 11768

BY EMAIL:
Fill in the form below and submit by email.

ALL INFORMATION IS REQUIRED!

____________________________________________

Name of Student

Date of Birth

Parent/Guardian
if under 21

Telephone #1

Telephone #2

Mailing Address:

Town/State/Zip

Your E-Mail

Please list the classes you wish to attend and the date you will begin classes:

Membership Fee of $40 for School Year will be paid by: