Name *

First Name

Last Name

Phone Number *

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If you are also registering for the next semester of B.O.M.B. Squad, what semester will this be for you?

First

Second

Third

Ongoing

Chose Only ONE of the Participation Options

In-Person or Virtual Participation

Detroit (In-Person at 16455 Woodward Highland Park, Michigan 48203)

Detroit (Virtual Only / Outside the State of Michigan)

Inkster (In-Person at Middlebelt Baptist Church - 943 Middlebelt Rd Inkster, MI 48141)

What's Your Preferred Method of Contact?

Email

Phone Call

Text Message