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* 1. I would like to register for the following course(s):

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* 2. Email address:

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* 3. First name:

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* 4. Last Name:

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* 5. What city do you live in?

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* 6. Ethnicity:

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* 7. You are:

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* 8. Age of child:

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* 9. What is the disability of the child/person?

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