시니어 북클럽 & 합창교실

시니어 북클럽 & 합창교실

Senior Program
Your Information (본인 정보)
Full Name(한국어)*
Full Name(영어)*

First NameLast Name
Gender (성별)*

Male(남자)Female(여자)
Date of Birth (생년월일)*

MonthDayYear
Date
Phone Number (전화번호)*
E-mail(이메일)
example@example.com
Address(집주소)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status (결혼 여부)

Single(미혼)Married/Remarried (기혼)Divorced (이혼)Widowed (사별)
Marital Relationship (부부 친밀도)

Good (상)Fair (중)Poor (하)
Number of Children (자녀수)
Intimacy between Parent and Child(ren) (자녀와의 친밀도)

Good (상)Fair (중)Poor (하)
Average Annual Income (연간 수입)

$0-$30,000$30,000-$50,000$50,000-$80,000Above $80,000
How did you hear about Family Touch program? (이 프로그램을 어떻게 접하게 되셨습니까?)*

패밀리터치 교육/상담 (FT Educations/Counseling)이메일 홍보 (Email Advertisement)친구/지인 (Friend/Acquaintance)카톡, SNS(Facebook, Instagram, Missyusa, etc.)신문 (Newspaper)교회 (Church)Other
Payment (수업료 결제)
Payment Options (결제 방법)*

Credit CardCheck
Payment By Check (체크결제)

체크를 Family Touch 앞으로 발행하셔서 218 Main Street, Little Ferry, NJ 07643으로 수업 이전에 발송해 주십시오.

Payment By Credit Card (Senior Book Club & Singing Class)

수요반 수업료(Wednesday Program Fee)

$120.00

Total

$0.00

Your Information (본인 정보)