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Registration Form

How did you hear about this course? *
Why would you like to enroll in this course? *
Contact Information- EMAIL Address *
Contact Information- Phone Number (Work or Cell) *
Would you like information on NY State's EIP Scholarship Fund to cover the cost of this course (if eligible)? *
Do you understand that this course is 70-hours (meeting over the course of 10 months)? [Current class meetings are virtual.] *
Is there any extra information you think we should know?
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