ASL Class Registration Form
Registrant Information
We are so pleased you're interested in registering for an American Sign Language class at Deaf Action Center! Please complete this form to register. You will receive a confirmation email with your registration details. Thank you!
Contact Details
First Name
Last Name
Phone
How did you hear about us?
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Television Segment/News
Web Search (Google, Yahoo, etc)
DAC Website
Friend or Family Member
Radio Ad
Other
Email
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Street Address
City
State
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AL
AK
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AR
CA
CO
CT
DE
DC
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HI
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IL
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LA
ME
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MA
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OK
OR
PA
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VA
WA
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Zip/Postal Code
I am
Deaf
Hearing
Hard of Hearing
Class Selection
All classes take place from 6:30-8pm Central, unless otherwise noted.
What Level of ASL Class are you interested in?
ASL 101
ASL 102 (Pre-Requisite: ASL 101)
ASL 103 (Pre-Requisite: ASL 101, 102)
ASL 104 (Pre-Requisite: ASL 101, 102, 103)
ASL 101-104 (See All Adult Classes)
How much TOTAL for the Classes Signed Up for
Demographic Information
Why do we ask for this information? Our organizational funding depends upon the clients that we serve, and having this information helps us provide transparency and accountability to our funders. We appreciate your help!
Birthdate
Primary Language
Please select...
ASL
English
Spanish
Other (Please specify)
Gender
Please select...
Male
Female
Non-Binary
Prefer Not To Say
Race (please select all that apply)
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Asian
Hispanic/Latino
Native American
Native Hawaiian/Pacific Islander
Black/African American
White/Caucasian
Other
Marital Status
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Married
Widowed
Divorced
Separated
Never Married
Veteran Status
I am a veteran or active service member
I am not a veteran
Interested in other things happening at DAC?
Communication Preferences:
Subscribe to DAC Newsletter
Let me know about upcoming events
I am interested in volunteering at DAC
I am interested in upcoming classes
Payment Details
Registration Fee
Additional Donation to DAC (Optional)
Total Amount to Charge:
Payment Information
Name as it appears on card:
Card Number
MM
YY
Code
Email for Receipt
Contact Information