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Pixelle Training Registration Form
Maiden / Other Birthname
Birth Date (MM/DD/YYYY format):
(Please be accurate - this information is used to create your initial password.)
Please select the gender with which you most identify:
Your race (select all that apply):
Ethnicity (check one):
Education (highest completed):
Release of my educational records:
Address Line 1
Address Line 2
Primary Phone Number
Confirm Email Address
Please enter the name of the short-term course you are interested in taking.
Press the submit button below to submit your course registration. We will contact you shortly. If you have any questions please contact Workforce and Professional Development at (207) 755-5282.