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2022-23 Milal Mission ClASS AGAPE Registration Form

Fill out the form carefully for registration
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Name of parent or guardian 1

First Name Last Name
Mobile Number
E-mail
example@example.com
Name of parent or guardian 2

First Name Last Name
Mobile Number
E-mail
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Any questions?

Pastor June (임현정전도사) : TEL. 267 815 6211 Email: milalloveclass@gmail.com
Should be Empty:

2022-23 Milal Mission ClASS AGAPE Registration Form