Healthy for Life Registration

Healthy for Good Registration Form
Hi there, thank you for your interest! These workshops will be hosted at the Modern Maturity Center (Dover) and Central Branch YMCA (Wilmington). We ask that if you register, you commit to attending all 4 workshops. Participants who complete all four classes are eligible to receive a gift set (limited 1 per household).

Dates, Times & Locations:

Cohort 2

Wednesday, October 15, 22, 29 & Tuesday, November 4
10:00 – 11:30AM
Modern Maturity Center Conference Room
1121 Forrest Ave, Dover, DE 19904

Cohort 3

Thursday, October 23, 30 & Thursday, November 6, 13
5:30 – 7:00PM
Central Branch YMCA – Wilmington
501 W 11th St., Wilmington, DE 19801
1. First and Last Name*

First NameLast Name
2. Mobile Number*
Please enter a valid phone number.
3. Email*
example@example.com
4. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Food Screening Questions:
5. Any food allergies? *
6. Please indicate which session you plan on attending*

Modern Maturity Center – DoverCentral Branch YMCA – Wilmington
Should be Empty:

Healthy for Good Registration Form