Holy Martyrs of Vietnam Church

Vietnamese Language School

915 S. Wakefield Street, Arlington, VA 22204

STUDENT REGISTRATION FORM

 2009 -2010 School Year

Opening of School: September 18, 2009 at 7:00 PM

in the Education Building next to the church

Weekly classes from 7:00 to 8:30 PM

Name: . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . . . .

Address: . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . .

. . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . .

Telephone numbers: (H) . . . . . . . . . .  . . . . . .

                                    (W) . . . . . . . . . .  . . . . . .        

                                    (Cell) . . . . . . . . . .  . . . . . .

E-mail address: . . . . . . . . . .  . . . . . . . . . . . . . . . .  . . . . . .

I would like to register for the Vietnamese Language Class for Adults for the 2009-2010 school year.

Enclosed is a check ___, cash for $50.00 for tuition.

Arlington, August                 2009

Signature