BSLC New Member Application
We Empower Students To Flourish Through Personal Relationships, Genuine Engagement, And Self-Directed Learning.

For more information, visit https://www.baystatelearning.org or contact 781-355-6575
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Member's Name *
Member's Date of Birth *
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DD
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YYYY
Member's E-mail Address *
Member's Address *
Member's Phone Number (Primary Contact) *
Example: 781-355-6575
When do you plan to start attending BSLC? *
MM
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DD
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YYYY
Will you be attending full-time or part-time (Part-Time limited to 2 days)? *
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