Enrollment Form for Up Your Voltage! and UYV Graduate Class

Download the Form Here

Class & Enrollment Form for "Up Your Voltage!" and UYV Graduate Class

40 Boyd Street, Worcester, MA  01606·Phone: 800.939.7909 · Fax: 508.856-9280
Email: craig@fixhybrid.com

Class & Tech Information

Class Location*:

Class Dates* : Month Date(s) * *Year 20

Shop Name*:

Street*: City*:

State*: Zip*:

Name of Student #1*: Cell #*: -

E-mail Address of Student*:

Spouse / Partner #1:

Fee for Student*: $ Spouse / Partner (Includes meals): $

Shop Contact (one responsible for payment)*:

Shop Phone (area code)*: - Fax number*: -

What scan tool or scope will you bring:

Do you have high voltage gloves?

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

Credit Card Payments

Name On Card: Total Charges to Card: $

Credit Card Number: Security Code:

Credit Card Type: Exp: /

I authorize my CC  for payment of the entire class. Sign here __________________________________________

Print name Today's date   __________/_________/_________

Airline Information

Name of Airline: 

Flight # : Lands at Time: on Date /

Call the office before booking flights so we co-ordinate picking you up  

Flight #: Takes off at Time: on date /

Driving Information

Are you driving a Hybrid? 

Make: Model: Year:
 
REFUNDS

Refund Policy: No refund 30 days before start of class.
Full refund minus $800 non-refundable enrollment fee if cancelled in writing 30 days ahead or you can substitute

another qualified person. 

I understand the refund policy   ____________________________________________________

 
DISCLAIMER:
“Please understand that although we have never canceled an UYV class, please buy refundable airfare. The best airline for this courtesy is Southwest Airlines. ACDC is not responsible for any cost you incur if we cancel or postpone a class”.
 

Use one form per tech/partner or spouse
Print & Fax form to 508 856-9280 (secure fax) or Email to   craig@fixhybrid.com