ACT Lawrence Intake

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* 1. For what type of class are you registering?

In person class (Only in Spanish)

Online class ( Available in English & Spanish)

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* 2. First Name:

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* 3. Last Name:

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* 4. Address:

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 5. What is your date of birth?

Enter date of birth: