CMA Adult Distance Learning Registration
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Organization Address
*
Organization/Site Name
Street Address
City
State / Province
Postal / Zip Code
Number of participants
*
Which platform do you prefer for your connection?
*
Zoom
Other
If you selected "other", please provide additional detail below. (Please note: the CMA may not be able to accommodate the use of additional platforms. A staff member will reach out to discuss possibilities for your connection.)
Preferred length of time for lesson
*
45 minutes
60 minutes
Please enter your first choice date for the lesson. (Dates should be at least two weeks from today.)
*
-
Month
-
Day
Year
Date
Please enter your second choice date for the lesson. (Dates should be at least two weeks from today.)
*
-
Month
-
Day
Year
Date
Preferred start time
*
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
Desired topic
Special Topic (Please specify desired topic in the comments section)
Please provide any comments/additional information, as well as desired topic.
Submit
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