LTC Class Registration Form: Lee Watkins-Rev1
  1. All information marked with (*) is required.

  2. List your name as you want it on your class name badge. It must include your last name,
    but you can use a legal first name or nickname.
  3. Name(*)
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  4. List your legal name as it appears on your driver's license.
  5. First Name(*)
    Please let us know your name.
  6. Middle Initial (Enter NMI if no middle name)(*)
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  7. Last Name(*)
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  8. Suffix
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  9. Driver's License - State(*)
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  10. Driver's License Number(*)
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  11. Please provide your contact information and address.
  12. Email(*)
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  13. Please re-enter email address(*)
    The email addresses do not match. Please re-enter.
  14. Preferred Phone No.(*)
    Invalid Input - Use xxx-xxx-xxxx format.

  15. Registering for:(*)




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  16. You do not need to have a PayPal account. You can pay with any credit card.
  17. Select method of payment.(*)
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