2. First Name*
3. Last Name*
5. Adult Programs

   Please select the program you are signing up for. If you do not see the program listed, it has reached capacity.

   1. Book Club 10/5 @ 11AM
   2. Breast Health Awareness, Presented by Jupiter Medical Center 10/11 @ 11AM
   3. Crafts for Grown Ups 10/19 @ 11AM
   4. Book Club 11/2 @ 11AM
   5. Medicare Part D 11/8 @ 11AM
   6. Identity Theft 11/15 @ 10AM
   7. Computers 101 11/29 @ 10AM
6. Children Programs

   Please select the program you are signing up for. If you do not see the program listed, it has reached capacity.

   1. Tween Crafts: Recycled T-Shirt Book Bags 9/27 @ 3PM
   2. Lego Club 10/17 @ 2:30PM
   3. Kids Art 10/20 @ 3PM
   4. Lego Club 11/7 @ 2:30PM
   5. Kids Art 11/17 @ 3PM
   6. Lego Club 11/21 @ 2:30PM
8. Amount (Children Programs Only)

   If you are signing up for a children's program, please indicate the number of participants that are being signed up.

9. Daytime phone number*
11. Address
    303 Anchorage Drive. North Palm Beach, FL 33408
12. Email*
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

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