Date: Wednesday, March 5

Time: 6:00 PM (Meet up at church) ; 7:00 PM (Worship Night)

Fee: $70.00 per student

Location: Somahng Church; Prudential Center

451 Grand Ave Palisades Park, NJ 07650

Student #1 Name

First Name

Last Name

Phone # / Parent Phone #

(###)

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Student #2 Name

First Name

Last Name

Student #3 Name

First Name

Last Name