Course Registration Form

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* 1. Student name:

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* 2. Email:

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* 3. Phone:

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* 4. Address:

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* 5. Date of birth:

Date / Time

Date

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* 6. Gender:

Man

Woman

Non-binary

Prefer to self-describe, please specify

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* 7. Which course(s) are you enrolling in?

Course A

Course B

Course C