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Account Information Class Date Please Check Our Schedules Please include the time of the class you are registering for. Please be sure to register for class at least a few days prior to the first day of class.     Class Time AM Class PM Class Class Location Dodge Park Warren Admin Bldg.     *E-Mail Address     School Attending     I Wish to Register For: Segment I   Segment II

Personal Information *First Name *Middle Name *Last Name *Birthday: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910 *Address *City *Zip Code *Primary Phone Alternate Phone     I Agree to the Terms of Registration