Wellness Program Event Registration
Focusing on Physical, Spiritual & Nutritional Health
Event Time: January 2021 - March 2021
Event Location: UMZ
Contact Dr. Darrlyn Cornelius-Averhart e-mail: zrv4@cdc.gov or e-mail: UMZChurch@gmail.com
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Name *
Email *
Street Address *
City *
State *
Zip *
Email *
Weekly Exercise *
Current Weight *
Measurements: Chest *
Measurements: Waist *
Measurements: Hips *
Goal for the program: *
Any Chronic Health Issues: Check any that may apply *
Required
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