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Course Agreement / Contract
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Indicates required field
Date of ChokeSaver Class (MM-DD-YY)
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Class Start time (Hr:Min AM/PM)
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I/we agree to 'rate' terms...
*
Yes (I/we have read 'rates' link)
No
I/we agree to 'hosting' terms...
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Yes (I/we have read 'hosting' link)
No
I/we agree to 'cancellation' terms...
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Yes ($100 fee if not 48 hrs prior to class)
No
I/we agree to pay S.A.F.E. for services...
*
Yes (including nominal 'travel stipend')
No
I/we will pay by:
*
Check (personal or business)
MC/Visa -online (add 5% charge)
Cash (subtract 5% credit)
We have / provide:
*
Parking lot / off street
Parking garage
On street parking / FREE
On street parking / Meter
Restaurant Name
*
Restaurant website
*
Provide URL of your map/directions page
Name
*
First
Last
Your Title
*
Phone Number
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Email
*
Address
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Line 1
Line 2
City
State
Zip Code
Country
Will you allow (room for) 'Walk-ins'?
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Yes
No
Let's talk...
May we use your restaurant name as a reference (on our website)?
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Yes
No
Let's talk...
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