On-Line Application for Credit Card Applicants

***Refund Policy***

***Refunds of 100%, less a $25 processing fee, will be issued if the registrant cancels the class more than 7 days in advance. Refunds will not be issued if the registrant cancels less than 7 days prior to the opening of the class. If the instructor determines the student is not eligible to complete the class or if the student voluntarily decides to leave the class, refunds will not be issued. There will be a $10.00 fee to reschedule your class. Reschedules must be made more than 7 days prior to your original class date.***

Students are registered on a first-come, first-served prepaid basis. If your requested class date is not available, you will be contacted for an alternate date. Your spot will be held for one business day. To maintain your spot in the class you have requested, you must pay for your class by calling 816-478-3677 before 5PM on the next business day with your credit card information.

To see the 2007 class schedule to verify class availability click HERE.

Please provide the following contact information: - Enter your name as it would appear on your driver's license.

Name	Date of Birth Sex
Additional Name	Date of Birth Sex
Street Address	State of issue for Driver's License
Address (cont.)
City
State
Zip/Postal Code
Home Phone
Work Phone
FAX
E-mail
Enter class dates	class dates can be found in the schedule.
*Course cost is $215.00 for the BRC. The price for the Premium BRC is $280*

By submitting this form, I acknowledge I have read and understand the refund policy as stated above. I further understand that prepayment for my class will be made at the time that I call Rolling Wheels with my credit card information.