"Fulfilled" Registration
Study begins Oct. 2
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select one of the following:
*
$30 - One Person
$40 - Two People sharing one book
If registering as a couple: Second Person's Name
First Name
Last Name
My Products - Pay via Paypal
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( X )
One Person, One Workbook & One Book
$
30.00
Two People, One Workbook & One Book
$
40.00
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Please indicate which time you wish to attend:
*
Tuesdays 7:00-8:30 p.m.
Thursdays 9:15-10:45 a.m. *Daycare available
Saturdays 9:00-10:30 a.m.
*Please enter children's names and ages for Thursday child care:
Must call child care provider by 8:00 a.m. if not attending.
Submit
Should be Empty: