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Registration for EnhanceFitness, Walk With Ease, and A Matter of Balance
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First Name
*
Your answer
Last Name
*
Your answer
Birth Date
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MM
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DD
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How did you hear about our program?
*
Current participant
New-from a friend
New-other source
Street Address
*
Your answer
City
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Choose
Alameda
Albany
Ashland
Berkeley
Castro Valley
Cherryland
Dublin
Emeryville
Fairview
Fremont
Hayward
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Newark
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Piedmont
Pleasanton
San Leandro
San Lorenzo
Sunol
Union City
Zip Code
*
5-digit Zip Code, do not include the +4
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Main Phone Number
*
Enter only numbers, no dashes, parenthesis, spaces, or dots. Example: 5105551234
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Main Phone Number Type
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Cell/Mobile
Work
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Email
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A confirmation of your registration will be sent to this email.
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