2017 Bass Coalition Workshop Registration Form
Grace Evangelical Lutheran Church
Winchester, VA
June 16-17, 2017
Faculty: Dr. Donovan Stokes, Inez Wyrick, Kevin Johnson, Mark Rubinstein, Dr. Eric O. Hanson, Zach Rowden
First Name
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Last Name
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Birthday
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Street Address
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City
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State
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Zip
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Phone
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Email Address
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How did you hear about the Workshop?
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Will the applicant be under 18 at the time of the Workshop?
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