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Request Family Membership with Ecclesia Prep!

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We are excited about the upcoming school year and glad your family is interested in oining us.

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Primary Last Name Primary First Name Primary Email Username Password Confirm Password Secondary Last Name Secondary First Name Secondary Email If Secondary Email is entered above, should it also receive weekly email and forum notifications, etc.? Yes No Address City State/Country

For United States and Canada

For Other Countries State/Province Country

Zip/Postal Code Timezone Phone Phone 2 Children

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Show Child Info to Other Families Family Business/Services Weekly Email Update: Would you like to receive a weekly email update? Yes No Privacy: Include my family information in the membership on-line directory? Yes No

Forum Emails:

Would you like to receive forum notifications via email (not just the ones you create)? Yes No

Many Emails: Would you like to receive notifications IMMEDIATELY? Yes No

Delivery Type Whole Thread New Part Only

Daily Digest: Would you like to receive notifications ONCE A DAY? Yes No

Daily Digest Delivery Type Detailed Summary

Classifieds - Many Emails: Would you like to receive ALL classified notifications IMMEDIATELY via email: Yes No Classifieds - Daily Digest: Would you like to receive ALL classified notifications ONCE A DAY via email? Yes No Message to Homeschool Group Administrator:

Additional Questions:

1. Year you started homeschooling? 2. With what church are you affiliated?

Ecclesia Prep

9653 Nations Drive, Springdale, AR 72762

479-248-7236

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