New Beginnings Class

Tuesday Evening
6:30 - 8:00 p.m.

* = required information

*Last Name      

*First Name(s)   

*Home Phone

E-mail Address

*Street Address

*City      Zip 

*Please choose a date:  February 23rd, 2012

 *I / We will need child care:  NoYes  
         
If yes, you must register at least 5 days prior to the class.

          If yes, number of children