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Let's Talk Puberty, Girls! event registration

Number of tickets needed

Which day will you be attending?

Which session will you be attending?

Youth name

First

Last

Suffix

Second youth name

First

Last

Suffix

Third youth name

First

Last

Suffix

Fourth youth name

First

Last

Suffix

Fifth youth name

First

Last

Suffix

Support person's name

Title

First

Middle

Last

Suffix

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone number

Email address

Credit card information

Card type

MasterCard

Visa

Discover Card

American Express

Name on card

Card number

Expiration

CVV

Total summary x $20 per ticket

1900 South Ave.
La Crosse, WI 54601

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