Alpha Participant Form

Wednesday, September 08, 2010

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*Name:
Age:
*Phone:
*Email address:
Do you need childcare?:	Yes No
Childcare for how many kids?:
How did you learn about the program? (Check all that apply):	Poster Postcard Letter Church Bulletin Personal Invite by:
:
:	Other:
:

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Hayward Wesleyan Church | PO Box 507 10655 Nyman Ave | Hayward, WI 54843 | ph: 715/634-4613 fax: 715/634-7823 | email: hwc@cheqnet.net

Hayward Wesleyan Church | PO Box 507 10655 Nyman Ave | Hayward, WI 54843 | ph: 715/634-4613 fax: 715/634-7823 | email: hwc@cheqnet.net