DALBY TUTORING

Graduate School Admissions Tests

Registration Form - 1-on-1 Graduate Test Preparation 

Schedule: All  tutoring sessions are Monday through Thursday between 3:00 and 9:00 pm

during the school year and during the summer. Practice tests may be taken any day that we are

open.

Today's date_____________

Name _________________________________ Email address _________________________

Street address _____________________________ Home/cell phone _____________________

City, state, zip _________________________ College /University_______________

GPA __________ Graduation year __________ Major ________________________________

Previous test scores if available __________________________________

I prefer Monday Tuesday Wednesday Thursday (circle preference for day) at _______pm.

I am preparing for the LSAT GRE MCAT GMAT (Circle test that applies.)

I wish to take the actual test on___________________________________________

I have read and understand the course information. DalbyTutoring requires 24hours notice to

change or cancel an appointment; you will forfeit your payment for a missed appointment.

__________________________________________ student's signature

You must sign this form to enroll. We fill appointments on a first-comefirst-served basis.

Fees: $190 per hour and $50 per quarter-hour tutoring.

Please make checks payable to: Dalby Tutoring, Inc.

1401 Chain Bridge Rd; Suite 102

McLean, VA 22101.

or fax registration to: 703-821-3847

MasterCard or VISA Account # ___________________________________Exp. date ______________

CVV# (3 digit number on back of card)______________ Billing Zip Code _________________

Rev.8/29/08