English in Action Conversations NYU Unit Registration Form

English in Action Conversations NYU Unit Registration Form

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Please complete this form and all sections on the PayPal website in order to complete your payment for English in Action. We hope you enjoy your conversation sessions!
Name: *	First name: * Last name: *
Address: *	Line 1: * Line 2: * City: * State: * Select one... Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon ZIP: *
Phone (best number to contact you by): *
Email: *
EiA Registration One semester of conversation sessions costs $40. You will participate in one session per week. Please select " 1" in the drop-down menu below.
EiA Registration *	If attending, please select the number of EiA Registrations required: There is a 1 EiA Registration limit. 0 1 EiA Registrations @ $40 each
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