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Name of Person Completing This Form*

REGISTRANT Name*

Enter your Mailing Address in the fields below:*

Street Address City State ZIP Code

Email*

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Phone*

How did you hear about this program?*

Fivesparks Website

Nextdoor Harvard

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Consent and Waiver of Liability

Please read the terms here and then check the box below.

Acknowledgment*

I have read the Fivesparks Consent and Waiver of Liability terms and understand and agree to them.

Cancellation & Refunds*

Fivesparks and its program providers rely on a minimum number of participants in order to run their programs. If I am unable to attend, I agree to notify Fivesparks (by emailing admin@fivesparks.org) at least 3 business days in advance of the program. Late cancellation may result in registration fees not being refunded.

(WKSHP) Autumnal Card-Making Workshop*

Price:

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Card Number Expiration Date Security Code Cardholder Name

Autumnal Card-Making Workshop

October 12 @ 1:00 pm - 3:00 pm EDT