Tech It Up Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Guardian E-mail*
example@example.com
Guardian Mobile Number*
Authorization of Guardian*
Workshop Location?*
Course
Additional Comments
My Products
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Tech It Up T-ShirtPlease enter your size
$ Free QuantitySize



Workshop 1 FUMC GJ 7/9/23-8/13/23- Destroy/Build/Code/Take Home - 6 week course
$100.00 Quantity



Workshop 2 Computer kit Maker VBS-10 hour 3 Day course-TBD-waiting list
$75.00 Quantity



TEST CODE 1
$1.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Card Expiration

Security Code

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