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ALC Registration

A Little Curios - Mommy & Me

Child Information
Full Name
First Name Last Name
Birth Date

Month Day Year
Parent Information
Full Name
First Name Last Name
E-mail
Cell Phone Number

Area Code Phone 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
E-mail

Address

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

Payment Information
There will be 12 Classes for remaining for this session

Library Family Members $240 - Non Members $300 - Become a member today! $72 - Membership + $240 ALC Registration Fee = $312

Please note: Tuesday & Thursday Groups are Now FULL!
I would like to attend:*
Library Member AttendingNon Member AttendingI Would Like To Become a Library Member

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Total

$0.00
Should be Empty:

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