Alpha Registration

*First Name: 
*Last Name: 
Address:
City/State/Zip:
Phone:
*E-mail:
I plan to attend the course beginning Wednesday, September 29th
  Coon Rapids Campus (2135 Northdale Blvd NW; Coon Rapids, MN 55433)
I would like to be part of the Alpha Team.
I would like someone to call me to obtain more information about Alpha.
I will require childcare for children.
    
   
* Required information