2023 Chinn Power Packs Interest Form

1. First Name

2. Last Name

3. E-mail Address This question requires a valid email address.

4. Phone Number

5. Address

6. Preferred Contact Method

7. Date of Birth This question requires a valid date format of MM/DD/YYYY.

calendar

8. How many people total? (3 - 6) *This question is required.

9. Format? *This question is required.

10. Please select your package option (Please note: There are no make-up sessions): *This question is required.

For questions, please email Adrienne Lopez.