Community Enrichment On-Line Class Registration

 * Required Information
Please tell us about yourself :
       
 * First Name  
 * Last Name  
 * Street Address  
 Apartment No.  
 * City  
 * State  
 * Zip Code  
 
  
Daytime Phone  
Evening Phone  
 * E-Mail  
    

 *Neighborhood  
 Are you a Civic League Member ?  
 YES    NO
 Are you a Civic League Officer ?  
 YES     NO
 Current Occupation  
 Are you in need of disability amenities?  
 YES     NO
*How did you hear about this workshop?  

Course Requests
*Course Title
*Course Date
 
 
*Course Time
*Course Location
 
 
* How do you plan to use the knowledge gained from this course?
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