Get Air Ongoing Every Thursday
Fill out the form carefully and sign up of each participant.
Class Date
Thursdays - Jan 8th, 15th, 22nd and 29th from 4-6pm
Class Participant Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Age
*
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
City where you live
*
Number in Household
*
Number over age 62
*
Family/Parent/Guardian Name
*
First Name
Last Name
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
My Products
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January Monthly Family Donation
$
100.00
January Monthly Family Donation
January IRC Reimbursement
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Purchased Annual Pass to Get Air
$
Free
Purchased Annual Pass to Get Air
Total
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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