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Harmony School District Adult Registration


Please complete the enrollment form below for your participation in the Harmony School District Professional Development in Washington, D.C.

Name(Required)
(Please type your name and gender exactly as it appears on the ID you will bring on our program)
MM slash DD slash YYYY
Address(Required)

I have read and agree to Close Up’s Terms and Conditions. 

Medical Information: Your answers to these questions will remain confidential. 

Special arrangements require advance notice and planning. Please complete the section below.
Do you have difficulty with mobility that requires assistance to walk such as a wheelchair, crutches or cane?(Required)
Are you visually impaired (other than corrective vision such as glasses or contacts)?(Required)
Are you deaf or hard of hearing?(Required)
Do you have a disability, history of seizures, or any physically debilitating ailments?(Required)
Do you need any additional accommodations to participate in the program?(Required)
Please indicate below any dietary restrictions that need to be accommodated.

671 N. Glebe Road, Suite 900
Arlington, VA 22203

703-706-3300 or 800-CLOSE UP

CST-1002082-40:
Registration as a seller of travel does not constitute approval by the State of California.

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