Women's Health Symposium Registration Form

Submitted by admin on Tue, 04/28/2009 - 07:50.

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Please check the Women's Health Symposium events below that you'd like to register for:: *

William Raines High School, Jacksonville, FL (March 14th)

Essex County College, Newark, NJ (May 16th)

Wayne State University, Detroit, MI (August 15th)

Jackson State University, Jackson, MS (October 31st)

May I please have your name?: *

May I please have your address? : *

May I please have your zip code? : *

May I please have your phone number?: *

May I please have your email address?: *

What are your health and fitness goals?: *

Would you prefer a Vegetarian meal?: *

Yes

Are you over the age of 18? : *

Yes

Do you have any ADA Requirements or Special Needs?: *

Would you like to submit a question for our panel of health professionals to answer at the health symposium?:


Women’s Health Symposium
Health Education & Active Learning
The BET Summer Camp for Girls

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