REGISTRATION - Qi & Me w/Jen Podos - IN PERSON ONLY: 5/26/26 - 6/30/26

Event/Class Registration

You must complete the online registration for our Qi & Me w/Jen Podos program. Class sizes will be limited.

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* Last Name

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* First Name

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* Date of Birth

DOB

Date

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* Gender

Female

Male

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* Marital Status

Married

Widowed

Divorced

Separated

Single

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* Race

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* Ethnicity

01-Non-Hispanic

02-Hispanic

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* Address Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

County *

Email Address

Phone Number *

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* Preferred method of contact

Phone

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* Emergency Contact Information

Name *

Relationship

BEST PHONE NUMBER