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Community Wellness Classes Enrollment Form
Thank you for your interest in Marianjoy's Community Wellness Program!
Please fill out the form below for each person who will be attending.
*required information
First Name
*
Last Name
*
Street Address
City
State
Zip Code
Phone Number
*
Email Address
*
Which class(es) would you like to sign up for? (Please include the name of the class and the date)
*
How did you hear about this program?
*
Newsletter in the mail
Flyer in the mail
Newspaper ad
Newspaper announcement
Marianjoy Web Site
Church bulletin
Friend or family member
Other
If other, please explain:
Questions and Comments
Your reservation will be confirmed by phone sometime before the event takes place.
If you encounter any problems filling out this form, or have additional questions, please call us at (630)-909-7102.
