Form

Business/Organization's Name*

Director's Email

Enrollees to Add

List any new enrollees' Last Name, First Name/Gender/Birth Date/Enrollment Date/Address Line 1/Address Line 2/City/State/Zip Code/Email/Phone Number. Separate each enrollee with a semicolon.

Example: Last,First/F or M or U/mm.dd.yyyy/mm.dd.yyyy/Street Address/Apt Number or Suite Number/City/State/Zip Code/email/phone number with no spaces. Please use this exact format and do not add or omit any elements.

Enrollees to Remove

List the names and cancellation dates of any enrollees you would like to remove. Separate each enrollee with a forward slash.

Update to Current Enrollees' Records

If you need to change an enrollees records (like their email address, phone number, etc.), please list the enrollees name and the updated record information. Separate each enrollee update with a forward slash.