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Purchaser's contact information:
Class ID (Assigned by SAI)  
Class date  
Company  
Name (individual)  
Address  
City  
State  
ZIP  
Phone:   (include area code)
Alt. phone:   (include area code)
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Texas License to Carry Class Minimum Payment Add Cost/Student
Over Minimum
Total paid: Check or M.O. #
  $ 750.00 (6 students) $ 125.00

By submitting this form, I acknowledge that I have read and accept the terms and conditions of the Staying Alive, Inc., Cancellation and Re-scheduling policies.

 

 

Remit Check or Money Order to:

Staying Alive, Inc.
PO Box 126
Saint Hedwig, TX  78152



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