Center for Lifelong Learning Registration
**Cost: $12.00 for Members -- $20.00 for Non-members.**
Pay at door with cash or check.
Sign in to Google to save your progress. Learn more
Email *
Freedom & Slavery in Franklin County on the Eve of the Civil War
Name of ALL Attendees in your party: *
Please check the program or programs you are registering for below. You may use this form to register for one program at a time or you may register for multiple programs at once. IF YOU ARE BRINGING A GUEST WITH YOU, PLEASE COMPLETE THIS FORM ON THEIR BEHALF (you will have the option to submit a second form at the end), OR ASK THEM TO COMPLETE THE FORM (by clicking on the link on our website).  *
Required
Mailing Address: *
Please include Street Address, City, State, & Zip
Phone Number: *
Please include area code + phone number.
Do you have any special dining requirements such as the need for vegan, vegetarian, gluten-free, low sodium, etc. meals? If so, please specify. If no, please state "none". *
Thank you for registering for our program!
Unless otherwise informed, Phoebe Needles Center, Inc. will consider your reservation as permission to use your photograph in marketing materials including video and still photos and on our website.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms