Transformation Academy Sign Up - Develop Your Character and Inherit Your Destiny

Print out this form and mail to: ACCD 3290 E Spring St Long Beach, CA 90806 You can also fill it out and fax it to: 562-685-0600
General Information
First Name:_____________________________________		Last Name:________________________________
Street Address:_____________________________________________________________________________
P.O. Box: ________________	City:________________	State: ________	Zip Code:_________________
Phone:__________________________________________		Alternate Phone:___________________________
Email:_____________________________________________________________________________________

Payment Information:
Please Select Method of Monthly Payment: ____Check _____Credit Card
Please charge my credit card:	MC VISA	Other: _________________
#_______________-_______________-_______________-_______________			Expires on: _______/_______
Print Name On Card:________________________________________________________________________
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