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* 1. What programs are you interested in attending? Please check all that apply.

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* 2. What day(s) and time(s) are you available to attend a program? Please check all that apply.

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* 3. The Walking Program is currently being offered weekly at 1 pm on Thursdays at Mill Creek Park Walking Trail – (entrance by the golf course). If you are interested in joining the walking program, what specific days and times would be best for you?  Please check all that apply.

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* 4. Which currently scheduled events would you be interested in attending? Please use the box labeled, Other Topic, to add any other subject you would like us to include in our upcoming events.  All are free to attend. Please check all that apply.

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* 5. Do you know children whose lives have been impacted by a loved one’s cancer diagnosis who may be interested in attending a fun, non-medical program? Please consider children/grandchildren, neighbors, and friends, and indicate what age group below.  Please check all that apply.

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* 6. Where do you look for information on Yellow Brick Place programs? Please check all that apply.

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* 7. May we have your name and email so we can make sure you receive the notices for events you are interested in. If yes, please fill out your name and address below. Your information will not be sold or shared.

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