Cooking with CHOICES - Registration Survey
RequiredRequired Question(s)
Required 1.
The first series will be January 26th - March 8th. We'll be cooking every Tuesday evening from 6:00pm - 8:00pm.

Please tell us the child's name and age? Please type in the box below.
 

50 characters left.
Required 2.
The Cooking with CHOICES program is fun for the entire family!

Please tell us the adult's name that will be coming? Please type in the box below.
 

50 characters left.
Required 3.
How did you hear about the Cooking with CHOICES program? 
Health Fair
From a Friend
Email
Other  
Required 4.
Please tell enter the information indicated below so that we can reach you!

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code: