Registration Form


	Working Mommies Network


	Registration Form


	10:30


	$110.00

6 month package

Start Date:


	$220.00


	10:30

12 month package

Start Date:


	Subtotal:


	Tax:


	Total:


	Name:


	Address:


	City:


	State/Prov:


	Country:


	Zip/Post. code:


	Phone:


	E-mail:


	Child's Name & Age

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	631-804-8531

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