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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth 

Date / Time

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* 4. Email 

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* 5. Contact Number 

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* 6. Are you interested in registering for a WINc Cohort? 

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* 7. What class format works best for you?

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* 8. When can you begin

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* 9. Are you interested in continuing on to attend GTCC to obtain your certificate. 

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* 10. Will you need childcare while attending the classes? 

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