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* 1. Name

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* 2. Please confirm you are over the age of 18.

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* 3. Address

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* 4. Phone

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* 6. If you would like to request seating with another participant, please indicate by including the participant's name, phone, and email address.

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* 7. Please list any children (under age 12) needing free child care during sessions.

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* 8. Do you or your children to whom we will be providing child care have any dietary limitations?

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