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2. Palm Beach Gardens Recreation Department
4. Name of Company or Instructor*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Email Address*
13. Phone Number*
15. Contact Person*
17. Description of Proposed Program or Activity*
19. Details of Qualifications, Certifications or Experience*
21. Instructor Bio (tell us more about yourself)*
23. Instructor Photo*
24. Company Logo (if applicable)
26. Supplies that Students Would Need to Bring*
28. Supplies that Instructor Would Provide*
30. Professional Reference #1*

    Please list name, phone number and email address.

31. Professional Reference #2*

    Please list name, phone number an email address.

33. Thank you for submitting your information. A representative of Palm Beach Gardens Recreation will be in touch soon!
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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