Lafayette Info Session Registration

I want to attend the following Info Session(s) in Lafayette: (Hold CTRL to select multiple dates) *

200 Professional Ct., Suite F, Lafayette, IN 47905

First Name* *

Last Name* *

Email* *

Phone* *

Address* *

City* *

State* *

Zip* *

How many will be attending? *

Please list names of those attending with you

If you are human, leave this field blank.