Spark 101 Registration Form 1Student Information2Support Person Information3Payment Information Step 1: Student Information Student Name* First Name Last Name Student Email*We'll use this to register you for the Celebrate EDU site Student Cell Phone NumberOptional. We'll use this for text reminders, if you want them!Choose Your Preferred Start Date for Spark 101* August 30 September 13 September 27 Is the person filling this out the student who is participating in Spark 101?* Yes, I am the student No, I am a family member/friend of the student Part 2: Support PersonThe support of friends & family is really important to us. Please share the information of the support person that will be assisting the student through Spark 101:The support of friends & family is really important! We ask that Spark 101 students have a support person that will be available throughout the course. Please share their information with us:Support Person Name* First Name Last Name Support Person Email Address* Support Person Cell Phone NumberOptional. We will only use this if we are having trouble getting in contact with the student.Support Person relationship to the student* Family Member Friend Staff Other Spark 101Spark 101 Price: $99.00 Price: Part 3: Payment InformationCardholder Email* Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Discount CodeIf you have a discount code, enter it here and click "apply". Credit CardCard Details Cardholder Name Payments are securely processed through Stripe. Your card information is protected with SSL encryption and SCA (Strong Customer Authentication) and is not stored on our servers. Total $0.00 NameThis field is for validation purposes and should be left unchanged.