Wellness Wednesdays Registration Form

Wellness Wednesdays Registration
Thank you for your interest in enjoying a Wellness Wednesday break with us.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email address. The link for the virtual event will be sent to you by email. *
example@example.com
You are registering to virtually attend:

Lydia Qiu and Friends, musical concert - May 26, 4:30 PM
Where did you hear about this virtual event?

Facebook Referral Instagram Twitter JFS Newsletter You Tube JFS Representative
Do you want to register more people?

Optional

Add a donation to help support JFS WISE and Thrive programs (Optional) $ 1.00

Dollar amount of your gift

Amount

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00