Living Healthy Workshop Self-Referral 2018 Participant Information Question Title * 1. First & Last Name Question Title * 2. County of Residence Allegany County Broome County Chemung County Livingston County Monroe County Ontario County Tioga County Tompkins County Schuyler County Seneca County Steuben County Wayne County Yates County Other (Please specify.) Question Title * 3. Contact InformationPlease provide your preferred method(s) of contact. Phone Number Email Address Done