Program Withdrawal Protection

Student Information
Program Information
Payment

LPI Program Withdrawal Protection is an OPTIONAL service and is not required to participate on an LPI program. By completing this form and submitting it to LPI you are agreeing to pay the additional withdrawal protection cost.

Add Cost to Program Balance: Add the additional cost for the Program Withdrawal Protection to program balance.
Personal Check: Checks should be made out to LPI and mailed to the address below.
Credit Card: Complete the Credit Card Authorization and mail or fax to LPI.

 
Learning Programs International
1112 W. Ben White Blvd.
Austin, Texas 78704

Fax: 512.275.0770

NOTE: Program Withdrawal Protection is not valid until payment has cleared.

Acknowledgement

By entering in my name in the space provided below, I, the "Parent/Legal Guardian" of the "Student" indicated on this form, acknowledge that I have read and agree to the policies of the LPI Program Withdrawal Protection and agree to pay the cost for that protection.

 
By clicking on "Submit," I affirm that all information supplied is true and correct to the best of my knowledge.