Community Wellness Group Registration Form
Whether you’re forming a new group or adding wellness to an existing one,you are helping bring valuable health information and inspirationto your community. By volunteering as a group leader, you’ll receive all the materials you need to guide engaging, educational, and fun discussions — and encourage others to live healthier lives. Only one person needs to complete this form to register your Community Wellness Group. This person will serve as the main contact and receive the monthly Wellness Wednesday materials by email. Individual group members do not need to sign up.
Group Leader's Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
What type of group do you represent?
*
Business
Church
Club
Community
School
Other
If other, please tell us what kind of group.
*
Group Name
*
Location (City)
*
Submit
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