Alpha Registration
First Name Last Name
Street
City State Zip Code
Telephone
Email Address
To help us plan the small groups, can you please tell us your age:
Marital Status (optional) Single Married
Please check the Alpha Course you are registering for:
Tuesday Sept 21 - Nov 23, 9:30 am - 11:30 am in Arden Hills
Tuesday Sept 21 - Nov 23, 6:00 pm - 9:00 pm in Arden Hills
Thursday Sept 23 - Nov 18, 6:00 pm - 9:00 pm in Roseville (no childcare provided)
Yes, I will need child care. Childcare for ages 12 and under is available on Tuesday morning or evening only. If childcare is needed, please check this box and give names and ages of all children attending. Child 1 Name: Child 1 Age: Child 2 Name: Child 2 Age: Child 3 Name: Child 3 Age:
Yes, I will need child care. Childcare for ages 12 and under is available on Tuesday morning or evening only. If childcare is needed, please check this box and give names and ages of all children attending.
Child 1 Name: Child 1 Age:
Child 2 Name: Child 2 Age:
Child 3 Name: Child 3 Age:
Special Requests:
