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Salaamalaikum!
This is the registration for the Chrome Club virtual class.
6
Questions
START
1
Your Name
*
This field is required.
First Name
Last Name
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2
Participant's Name
*
This field is required.
First Name
Last Name
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3
Date of Birth
*
This field is required.
Date
Month
Day
Year
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4
Your e-mail address
*
This field is required.
example@example.com
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5
Cell number
*
This field is required.
Area Code
Phone Number
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6
Please select the days and times that work for you.
*
This field is required.
Mondays 11:00-1:00
Mondays 2:00-4:00
Tuesdays 11:00-1:00
Tuesdays 2:00-4:00
Wednesdays 11:00-1:00
Wednesdays 2:00-4:00
Thursdays 11:00-1:00
Thursdays 2:00-4:00
None of these times work for us.
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7
Fee
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( X )
This class is $5 per participant
USD
+ OR enter a custom value
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