Cross Cultural Communications,Inc

Registration form for mini programs only

Select a language (a) Spanish   (b) ESL  (c) Accent reduction   

 Select  Children/teen program (   ) adult program (  )

Name __________________________

Last name______________________________

Address_________________________________ ________________Town__________State_____

Mobile number ________________________


Payment by credit card  # ___________________________________________

Expiration date ___________

vin _______________________

Signature to accept charge __________________________ 

Program selected (  ) a  (   ) b   (  ) c (  ) 

Classes meets for 45 minutes/1x week/  for 5 weeks. Program cost $261* for a private full immersion class.


Visa (   ) Mastercard (   ) American Express (  )  discover (   )  bank  check (   )  cash (   )



Mail in your payment with registration form to ;CCC, Inc

58 Bergen St, Westwood,  N.J.,07675 201 263-1443 or email us the form 

*Material is included. Should you withdraw, only a credit good for life of program is granted.

No make up classes is given if you miss a class. Only if the center is closed due to inclement weather we will offer a make up class.

 Date program starts ________________ends ________________

+Call center for prices on  our tutoring, Bilingual Child and other Spanish and ESL Programs.