Next Step-We The People Adult Program Application/Registration


	All participants that completes this eligibility session can select Session 1, 2, 3 or 4. The Program is located at 727 4th Street South, La Crosse, WI 54601.


	Next Step-We The People Adult Application Form

E-mail Address: *

First Name:

Middle Name:

Last Name:

Address:

City:

State:

Zip Code:

Area Code and Phone Number:

Date of Birth: / /

Ethnicity

If Other Please State:

What Session are you Attending? *

Why did you Register?

How did you hear about us?