DICE

Enrollment Form

Please complete the form below and submit. You will be taken to our PAYPAL page to make the payment. Thank you for your interest.

  Student/Participant Information
 
*First Name: *Last Name:
*Date of Birth: * Gender
 
  Contact Information
 
*Contact/Parent Name: *Contact/Parent Email:
* Home Phone: Cell Phone:
* Address: * City:
* State: * Zip Code:
 
  Program Interested
 
* Program/Session: Math Classes by GEMS - Spring 2018 - E5 (Grade 5) * Start Date: 03/10/2018
* Schedule: Saturday 9AM to 10:30AM * Cost: $225
 
Please click the Pay Now button below to make a payment online. Please note that there is a 3.5% processing fees to pay online.
 

   


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Address: 24555 Novi Rd, Novi, MI 48375                          Phone: (248) 962-3678                 Email: detroitindiancenter@yahoo.com