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* 1. Name

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* 2. Phone Number

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* 3. Email Address

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* 4. Contact me about upcoming classes

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* 5. Programs of Interest (Check all that apply)

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* 6. Are you interested in learning to play an instrument?

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* 7. Are you interested in learning to paint?

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* 8. Preferred Location (Check all that apply).

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* 9. Preferred Time (Check all that apply).

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* 10. Preferred day of week (Check all that apply).

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