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2. First Name*
3. Last Name*
5. Email Address*
7. Proposed Class Title
9. Class Description*
11. Dates / Times Availability *
13. Estimated Registration Cost (if applicable)
15. Target Audience

    1. Pre-school (0-5 years)
    2. Youth (6-12 years)
    3. Teen (13-19 years)

    1. Adult (20-54 years)
    2. Active Adult (55+ years)
    3. Special Interest (age, ability, etc.)
17. Activity Category

    1. Arts
    2. Fitness education / health
    3. Fitness program
    4. Group exercise

    1. Cycle programs
    2. Water aerobics
    3. Athletics
    4. Other
19. Résumé
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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