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Class Coordinator:_____________________ Home phone:_________
Cell: __________
Address: _____________________________ City
_______________ State __ Zip _____
Class location: ________________________ Type
of facility: _____________________
Class sessions and times: ___________________________________________________
Fully registered participants:
1. _________________________________________ 6.
___________________________________________
2. _________________________________________ 7.
___________________________________________
3. _________________________________________ 8.
___________________________________________
4. _________________________________________ 9.
___________________________________________
5. _________________________________________ 10.
__________________________________________
Special information and prayer requests:
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Office use only:
Sent to: _______________________________________________________________________________________
Set #: ___________ Sent: ___________ Via: ___________
Expected back: ___________
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