Online Membership Registration

This is a secure registration form. Your information will not be shared with any other company and will be transmitted using a secure server.

PLEASE NOTE

Be advised: As of 1-1-2014 the states listed below have stopped using the GED test and will be using a test from another publisher.
Indiana, Iowa, Louisiana, Maine, Massachusetts, Missouri, Montana, New York, West Virginia

Before registering, please review the DCS GED^® Prep Online tour of features and read the important facts about the GED^® Test. Then, fill in and submit this form. You will receive a registration letter by email after your payment has been received and processed. Please allow one business day for the email to arrive.

Your registration letter will be emailed to you and will include:
   — your user name and password
   — 4 month membership to complete your studies
   — password protected access to all DCS GED^® Prep Online features for four months

The cost of membership is $65.00 USD. ($68.58 for Wisconsin residents)
If four months time is not enough to complete your studies, you may continue your membership for $10.00 (US dollars) per month.

Student Information (* = required field)

How did you find us?*
Which one?

First Name:*

Last name:*

Address:*

Apartment or Lot Number:*

City:*

State:*

Country(if outside of USA)*

Zip Code:*

(Area Code) and Phone Number:*

Email Address:

Birthday(mm/dd/yyyy):

Month:

Day:

Year:

Social Security Number:

Last Year of school:

	White	Black	Hispanic	Native American	Asian	Other
Ethnicity:

	Male	Female
Gender:

	Yes	No
Did you attend any Special Education classes?

If there is any other information you want to share, please do so in this box.

Why do you want your GED?

Which version of GEDonline would you like?
English language version:
Spanish language version:

Method of Payment (You must select one method of payment*)

Credit Card	Mail a Check	Mail a Money Order	Purchase Order	PayPal

Payment details:

1. Credit

After you submit this registration form, you will see a Buy Now button on your confirmation page. Click the Buy Now button to enter your credit card information and pay for your membership.

2. Mail a Check

Make your check payable to DCOMS-SP and mail it to:
Diversified Computer Services
PO Box 2199
Kenosha WI 53141-2199

3. Mail a Money Order

Make your money order payable to DCOMS-SP and mail it to:
Diversified Computer Services
PO Box 2199
Kenosha WI 53141-2199

4. Purchase Order

Purchase order number:

Your purchase order can be faxed to 267-654-6979 or mailed to:

Diversified Computer Services
P.O. Box 2199
Kenosha, WI 53141-2199

The purchase order should list the student name and ID number. When your purchase order is received,
your username and password will be emailed to you.

5. PayPal

You can use your existing PayPal account or create a new PayPal account to pay for your GEDonline membership. After you submit this registration form, you will see a Buy Now button on your confirmation page. Click the Buy Now button to complete your payment.

After completing this form, please click Submit Form ONLY ONCE.
(If the Internet is slow, it may take several minutes to register. Please be patient.)
Your information will be transmitted via a secure server to ensure your privacy.