Registration Form - Summer Celebration
Customer Information
First Name (*)
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Middle Name (*)
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Last Name (*)
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Home Address
Street (*)
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City (*)
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State (*)
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Zip Code (*)
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Country (*)
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Citizenship
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Home phone (*)
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Work Phone
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Cell Phone (*)
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Email (*)
Please specify your email address.
Gender
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Place of Birth
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Level of Education
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Are you still studying?
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Passport Details
Passport No. (*)
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Issuing Country (*)
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Issue Date
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Expire Date
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Medical Condition
Do you have any medical Problems?
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If yes explain
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Are you on medication?
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What is the name of your medicine?
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Do you have medical insurance?
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Company Name
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Insurance No.
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Issue Date
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Expire Date
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Emergency Contacts
Name
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Day phone no.
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Night phone No.
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Payment
Registration Fees: $200 (non refundable)
Duration (*)

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(*)

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(*)
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Arabic Course (*)


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Accommodation (*)






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Weekend Tours (*)


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Cooking Class (*)


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Dabka Class (*)


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Current Total
Total
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I agree with the General Conditions
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Human Validation (*) Human Validation
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