HR 218 Registration Select Date * 11/5/24 11:30-12:00 11/5/24 12:00-12:30 11/5/24 12:30-01:00 11/5/24 1:00-1:30 11/5/24 1:30-2:00 11/19/24 10:30-11:00 11/19/24 11:00-11:30 11/19/24 11:30-12:00 11/19/24 12:00-12:30 11/19/24 12:30-1:00 11/19/24 1:00-1:30 11/19/24 1:30-2:00 Full Legal Name * Date of Birth * MM DD YYYY Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Emergency Contact Name * Emergency Contact Relation * Emergency Contact Phone * (###) ### #### Thank you!