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* 1. Your Name

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* 2. Your Title

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* 3. School/District Name

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* 4. School District

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* 5. Address

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* 6. Number of Annual Digital Licenses @ $5.95/Student?

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* 7. Order Total

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* 8. Payment Method (If paying by credit card, please use this order form)

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* 9. Check / Purchase Order Number

* Please mail checks to:
   LifePrep Academy
   PO Box 83384, Los Angeles CA 90083

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