Enquiry – BindraLearning inc.

Course Enquiry Form (Minor)

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Student Name

First

Middle

Last

Layout

School Name

Grade

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Student School City

Student Phone Number

Student School State (2 Letter Code)

Select Course

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Parent Name

Parent Phone Number

Parent Email ID

Parent Address

Address Line 1

Address Line 2

City

State

Zip Code

Additional Comments

All payments are accepted by Venmo and Paypal. Payment by cheque will delay signon until cheque clears. Make cheques payable to Bindralearning LLC. Programs conducted are over 10-14 week period limited to few hours a week.