Nextgen Senior Solutions: "Savvy Senior's Club" Monthly Meet-Up Registration Form
Name
First Name
Middle Name
Last Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age Range
50 - 59
60 = 69
70 = 79
80+
Gender
Please Select
Male
Female
N/A
Address
Which town do you stay?
Street Address Line 2
City
State / Province
Postal / Zip Code
What topics would you like to learn more about? (Check all that apply)
ChatGPT and AI basics
What is AI? I’m starting from scratch
Using AI to help with everyday tasks
Chatting with AI for fun, help, or writing letters
Using AI for business or entrepreneurship
Learning how AI helps prevent scams
Creative uses: writing, art, storytelling
Other
Monthly Meetups are on the Third Saturday of each month, Pick the Date you are Registering for:
September 20th, 2025
October 25th. 2025
November 22nd, 2025
December 20th, 2025
"Check Activites you will participate in:
(11am -12pm) FREE Intro to AI Class
(12pm - 1pm) FREE lite Exercise Class
(1pm- 2pm) Topic of the Month ($5 donation)
"Will You Participate in Any of the Following?"
Yes, I’ll join the free light exercise class
I plan to use the pool or jacuzzi
I’ll check out the exercise room
I want to try the VR experience (small fee applies)
I’ll purchase refreshments onsite (optional)
"Stay Connected?"
Yes, I’d like to receive future emails about senior-friendly events, offers, and learning resources.
Would you like to bring a friend or family member to class?
Yes
No
Maybe
Is there anything else you’d like to learn or ask about?(Paragraph answer)
For Caregiver or Loved One Referring a Senior:
Fill this section if the above info is another's
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Comments
Submit
Should be Empty: