Name *

First Name

Last Name

Dates & Times

Please select the day/times you prefer.

Wednesdays, 7 p.m. to 9 p.m.

Mondays, 7pm to 9pm

Private Classes

Other: Please specify

Name *

First Name

Last Name

Phone

(###)

###

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Dates and Times

Please specify which day/times you prefer

Second Tuesday, 6 to 9 pm

Fourth Saturday, 5 to 8 pm

Private Class

Other: Please specify

Name *

First Name

Last Name

Phone

(###)

###

####

January 7-8, 2022

MM

DD

YYYY

Name *

First Name

Last Name

Phone

(###)

###

####

Date

What is your estimated due date?

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YYYY