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*Required Information
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| *First
Name: |
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*Last
Name: |
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*Street Address: |
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*City |
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*State: |
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*Zip Code: |
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*Enter Number of Children By
Age Range: |
0-5
6-12
13-16
17-19
20+ |
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| *Are
You Currently Home Schooling? |
Yes
No |
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| If No, Are You Planning
to Home School? |
Yes
No
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Enter Source Code (printed above your name on the card pack Cover Card: |
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*How did you hear about us? |
Received card pack
E-mail
Friend
Search engine
Fax
Other
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| Comments/questions: |
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| Email Address: |
| I give my permission for The Christian Home School Connection to send me emails from time to time. |
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Do you have a home schooling friend who would benefit from receiving our Home School Card Pack?
Please enter their information below:
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| First
name: |
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| Last
name: |
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| Street Address: |
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| City |
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| State/Province: |
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| Zip/Postal
Code: |
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