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Registration Form

"Our destiny will not be written for us, but by us!" President Barack Obama
To secure your spot a total payment of $100.00 is due upon registration -- non-refundable

Student Name:		Email:
Parent Name:		Email:
Address:		City:
State:		Zip:
Parent Cell:		Student Cell:
Time to Call:

Gender:	Grade:

High School:		GPA:



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