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Membership Application

Student

First name *Last name *Street address *

City *State *ZIP *

School *Grade *

Phone *Email *

Mother

NamePhoneEmail

Father

NamePhoneEmail

I agree to receive news, updates, and promotional messages from LogiCore and Keystone Education by email and text message at the emails and phone numbers above. Message and data rates may apply. Reply STOP to opt out of texts at any time. This is optional and isn't required to apply.

* Required. Please give at least one parent's name, phone, and email.