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* 1. First Name:

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* 2. Last Name:

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* 3. Select your date

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* 4. Select your timeslot

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* 5. Cell Phone:

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* 6. Email Address:

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* 7. Company/Organization Name:

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* 8. Please send $50 payment via PayPal to katienavarra@yahoo.com and use the "friends and family" option to avoid fees.

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