Contact Information

* 1. Please provide your contact information

* 2. Emergency Contact

* 3. If yes, what is the name of your business?

* 5. Are you currently employed?

* 6. Name of current or previous employment.

* 7. Time employed at current/previous job:

* 8. How many employees were/are at your company?

* 9. Are you currently an employee with the City of San Pablo?

* 10. Demographics

* 13. What is your approximate average household income?

* 14. Pricing per course:

San Pablo Residents.........................................................$20
San Pablo Residents enrolling in all three courses............$40 total
Non-San Pablo Resident....................................................$50
Non-San Pablo Resident enrolling in all three courses.......$100 total
SPEDC Member.................................................................$30
San Pablo Business Owner................................................$40
Non-San Pablo Resident....................................................$50

Cancellation Policy: Registration fees are refundable ONE WEEK BEFORE CLASSES START. Cancellations after deadline will receive a credit towards next registration.

**Proof of residency will be required**

* 16. Register to the following courses (check all that apply):

* 17. How did you hear about these classes?

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