Name *

First Name

Last Name

Phone *

(###)

###

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I WILL ATTEND ON THESE DATES *

please place a check by all sessions you plan to attend

I will attend both sessions scheduled for Tuesday, July 23rd and Wednesday July 24th

January 11

February 8

March 8

April 12

May 10

June 14

July 12

August 9

September 13

October 11

November 8

December 13

Commitment

I agree to attend each session I signed up for.

I agree to allow my image (photo and vieo) to be documented as part of my participation in this activity.