JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Stepping On
Please enter the information below to register for Stepping On, March 3-April 14. Suggested donation of $10 can be paid on the first day of class.
Rice Lake Senior Center
12 W. Humbird
Rice Lake, WI
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your first name
*
Your answer
Your last name
*
Your answer
Best phone number for you
*
Your answer
Address
Your answer
Your e-mail address, if available
Your answer
How did you learn about Stepping On?
You can choose more than one.
The Source
The Focus
The Review
Newspaper article
Radio ad
Friend
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Barron Aging and Disability Resource Center.
Report Abuse
Forms
