REGISTRATION

I am registering for the Purpose + Path Workshop on the following date: *

SEE ABOVE FOR AVAILABLE DATES

MM

DD

YYYY

Student's Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Student's Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Cell Phone *with area code *

(###)

###

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I agree to accept detail/reminder texts for this workshop.

Confirm

Parent/Mentor Cell Phone *with area code *

(###)

###

####

I agree to accept detail/reminder texts for this workshop.

Confirm

By registering, I acknowledge that the Purpose + Path workshop is in English only and that all people in my party are proficient enough to participate. *

Confirm