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ALC Registration

Child Information
Full Name*
First NameLast Name
Birth Date*
MonthDayYear
Parent Information
Full Name*
First NameLast Name
E-mail*
Cell Phone Number*
Area CodePhone Number
All ALC updates will be sent via a WhatsApp Broadcast list*
I have saved Chanie Wolowiks number 516-698-1564 to receive all update

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Payment Information
There are 10 Classes this Session
Library Family Members: $180
Non Members: $250
If you are not yet a Family member and would like to become a Library Member: $150 + $72 = Library Membership $252
I would like to attend:*
*
I am a Library MemberI am a Non MemberI would Like to become a member

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Total
$0.00
Should be Empty:

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