Full Name
*
Phone
*
Address
City
State
Postal code
Email
Do you regularly check and use your email?
Yes
No
How do you want to receive your workbook?
By mail - I want a copy that is printed.
By email
What time do you work/go to school on Monday?
What time to do you work/go to school on Tuesday?
What time to do you work/go to school on Wednesday?
What time to do you work/go to school on Thursday?
What time to do you work/go to school on Friday?
What time to do you work/go to school on Saturday?
What time to do you work/go to school on Sunday?
Are you familiar with Zoom? The app for video conferencing on your phone? (or computer)
Yes
No
Submit!!
