Class Application 2023

Application Information

First Name (required)

Last Name (required)

Middle Initial

Date (required)

Street Address (required)

Apartment/Unit #

City (required)

State (required)

Zip Code (required)

Phone (required)

Email address (required)

Choose Month to take Class (required)

2023 Classes are now available for February, March, and April

Which Class Are You Applying For? (required)

Dent Repair 1 day class 6 hours 9:am-3:pm and evening class 4:pm-10:pm Rust Repair & Body Repair 3-day class is only held on Friday, Saturday and Sunday from 9:am-3:pm each day six hours and total course hours 18

Have you working in the automotive industry before? (required)

Yes

If Yes When? (required)

Military Service Discount 10%

Branch

Start Date

End Date

Rank at Discharge

Copy of Discharge

Disclaimer and Electronic Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to enrollment, I understand that false or misleading information in my application or interview may result in my release

Signature (Print Name)

Date Signed

Dezer Autoseum - 5250 International Dr. Orlando, FL 32819

*Students will be notified 14 days before the classes will begin, payment in full is required to secure your spot in the class.

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Mike Manning

mike@autoseum.org

President