Date: / /

Mr/Mrs/Ms:

Address:



Phone Number(Home):
Phone Number(Work):

Your Email Address:


Class Preferred:

Starting Date: / /

Time:

Second Class:

Starting Date: / /

Time:



It is the policy of James Rumsey Technical Institute not to discriminate on the basis of sex, handicap, race, color, or national origin in its educational and vocational programs, activities, or employment as required by Title IX, Section 504, and Title IV.

 

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