Contact Name *

First Name

Last Name

Phone Number *

(###)

###

####

Preferred Days of the Week *

Select whichever days would be most convenient for your class

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred Timeslots *

Select all 25-minute segments that would be convenient for your class

10:00am-10:25am

10:30am-10:55am

11:00am-11:25am

11:30am-11:55am

12:00pm-12:25pm

12:30pm-12:55pm

1:00pm-1:25pm

1:30pm-1:55pm

2:00pm-2:25pm

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