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Step Your Way to Health Registration Form
This is the registration form for Step Your Way to Health Participants.
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* Indicates required question
Email
*
Your email
Are you age 18 or older?
*
Yes
No
Name (First and Last)
*
Your answer
Phone Number
*
Your answer
Gender
Female
Male
Prefer not to say
Other:
Clear selection
Are Your Hispanic or Latino?
Yes
No
Prefer Not to Say
How do you identify yourself?
Native Indian/Alaska Native
Asian
Black/African American
White
Native Hawaiian/Pacific Islander
Prefer Not to Say
Clear selection
How did you hear about the class?
Facebook
Extension Website
Newspaper/New Channel
Other:
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