Adults Online Register Form

First Name:

Last Name:

Age:

Date of Birth:

Gender:
Select an option Male Female

Email:

Are you a new or returning student:
Select an option New Returning

Have you Studied Arabic or Quran before:
Select an option Yes No

If yes, please indicate which programs and when:

Please indicate your current Arabic level:

Course Preferences

Select your course preferences:
10 Lessons: $399 20 Lessons: $699 30 Lessons: $899

How many days per week:
Select an option 1 2 3 4 5

List 3 or 4 times in EST that you are available in; classes can take place
between 7am - 5 pm EST:

Address Line 1:

Address Line 2:

City:

State:

Country:

Phone Number (all communication will be via Telegram):