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2. Name of Organization*
3. Address*
   (Where class is to be held)
5. Date & Time for Class*
   Date & Time for Class

   Date & Time for Class
6. Classroom/Live Burn*

   Please select one or both

   1. Classroom
   2. Live Burn
7. Number of Attendees*
8. Age of Attendees*
10. Point of Contact*
    (Name/Phone #/Email)
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12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

* indicates a required field