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* 1. Your Contact Information

Thank you for using our online form to provide your contact information and sign up for our programs. Your contact information will also be used to send you monthly email and periodic postal service notices of SCOSA events.

Please remember to click the SUBMIT button at the bottom of the page so that your information will be recorded.

* 2. Please indicate your reason(s) for completing this form today: (Check all that apply)

* 3. Please enter your name in the box adjacent to each event you wish to attend. Please also mark your calendar for each one you plan to attend as you will not receive e-mail confirmations or reminders. If you don't see the program you're interested in, it may have a different registration procedure. Please check "Older Adult Education" at www.stockton.edu/scosa.

* 4. Our programs are free unless otherwise noted. We are partially funded under the Older Americans Act of 1965, as amended, which requires that we inform you that we gratefully accept donations for services provided. Donations will support ongoing programming. Also, we are required to collect basic demographic information. Your voluntary answers to the following questions help us determine eligibility for program funding and to secure future funding. Your answers will be kept strictly confidential. Thank you.

If you have any general questions about SCOSA, please email SCOSA@stockton.edu.

If you have any specific questions about any of the Older Adult Education programs, please email Mico.Lucide@stockton.edu

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