To confirm attendance for you and/or your spouse at the Day of Wellness seminar please complete the following information. Please remember to click the submit button at the bottom of the form. Registration may be limited by the number of participants responding.

All attendees will be eligible for raffle drawings including 2 iPADs and 2 Flat Screen TV’s as well as other gifts. The raffle drawings will be held after each seminar, and you must be present to win.

Click here for directions.

Name of Attendee:
Name of Spouse/Guest Attendee:
Phone Number of Attendee:
Total Number of Attendees:
E-mail Address:
Local Affiliation: