Scholarship Form Request
Please fill out this form for scholarship eligibility.  Specific class details, time, date and registration link will be provided thereafter.   There is a $20 registration fee per attendee that will be invoiced to the email provided and must be paid before you are officially registered for class.
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Name *
email address *
Cell Phone *
Organization (Company) Name *
Address *
city *
state, zip *
Scholarship interest (there is a $20 registration fee per  attendee for each class, to hold scholarship seat) *
Scholarship(s) Sponsor Name
LBX Collective Referral
Clear selection
Number of scholarships (max 3 scholarship attendees per company) *
Attendee #1 (name & email) *
Attendee #2 (name & email) (if applicable)
Attendee #3 (name & email) (if applicable)
Submit
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