40 Boyd Street, Worcester, MA  01606 ·Phone: 800.939.7909 · Fax: 508.856-9280
Email: Deb   vanbat55@yahoo.com  Deb 408 400 4656
 

Class Name: ________________________________ Class Dates: _______________________________

Shop Name: ___________________________________________________________________________

Street: ___________________________________ City: ___________________ State: ___ Zip: _______

Name of Student #1:  _________________________________________ Cell #: (_____)______________

E-mail Address of Student: ______________________________________________________________

Spouse / Partner  #1____________________________________________________________________

Fee for Spouse / Partner (Includes meals)  $199.00 each

Make / Model of Scan tool or Scope bringing to class: ______________________________________________

Shop Contact (one responsible for payment): _____________________________________________

Shop Phone (area code): (_____)______________       Fax number: (_____)______________

Paying by Check
Please make checks out to ACDC for total charges & fees.
Mail check 40 Boyd Street, Worcester, MA 01606

I authorize my CC  for payment of the entire class 

Sign here __________________________________________

Print name_________________________________________

Today's date   __________/_________/_________

Name of Airline  _________________________________   What Airport? City__________________State___
ACDC is not responsible for non-refundable airfare in case of changes.

Flight # ________________  Lands at Time: _______ pm on __________________ (day and date) 
Call Deb at 508 400 4656 before making flight arrangements

Flight # ________________ Takes off at Time: _______ pm on __________________ (day and date) 
Call Deb at 508 400 4656 before making flight arrangements 

Refund Policy: No refund 30 days before start of class.
Full refund minus $495 non-refundable enrollment fee if canceled in writing 30 days ahead or you can substitute another qualified person. 

I understand the refund policy   ____________________________________________________