BLS Class Registration Fall/Winter 2023/24
Last Name
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First Name
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Email
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Are you an employee of Haskell Memorial Hospital?
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Select the date of the class you wish to enroll in.
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Select the date of the class you wish to enroll in.
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By checking this box, I am agreeing to pay the fee of $40 via cash or check to Haskell Memorial Hospital for the class selected. (Due by start of class.)
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Mailing Address with City, State, and ZIP
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Cell Phone Number
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Send me a copy of my responses
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