English for Life (EFL) Registration
Name
*
First Name
Last Name
E-mail
*
Cell Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
What is the best way to contact you?
*
Phone
Email
Other
What is your first language?
How long have you lived in the United States?
I am interested in (check all that apply)
*
English classes - Thursday mornings - in person (women only)
Women's Bible Discussion & Fellowship - Tuesday mornings - in person
Men & Women's Bible Discussion - Friday evenings - Google Meet
Other
How did you hear about our English classes and Bible Discussion groups?
*
Friend
Neighbor
Flyer
Other
CHILDREN'S PROGRAM - BIRTH-5th GRADE
Reservation Deadline: September 1st each year. After this date, please email margie@coppellbible.org to confirm availability.
Number of children being registered for Children's Program
*
Please Select
0
1
2
3
4
5
1st Child's Name
*
First Name
Last Name
1st Child's Date of Birth
*
-
Month
-
Day
Year
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2nd Child's Name
*
First Name
Last Name
2nd Child's Date of Birth
*
-
Month
-
Day
Year
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3rd Child's Name
*
First Name
Last Name
3rd Child's Date of Birth
*
-
Month
-
Day
Year
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4th Child's Name
*
First Name
Last Name
4th Child's Date of Birth
*
-
Month
-
Day
Year
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5th Child's Name
*
First Name
Last Name
5th Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
CHILDCARE POLICIES
CLICK
HERE
FOR CB'S CHILDCARE POLICIES
Initial here that you have read and accept the CB Childcare Policies
*
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CLASS REGISTRATION & PAYMENT
The cost for ENGLISH CLASSES is $25 each year. How would you like to pay?
*
NOW with debit/credit card
LATER by check/cash ($25 due at first class)
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EFL Registration Fee
$
25.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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