Presented by Lori Glaser, PTA

Please fill out the information below to register for the 'Getting My Body Back' presentation. The event will run from 6:30pm to 8pm on Tuesday September 18th at the PDR clinic in Coon Rapids, 320 Coon Rapids Blvd NW #100, Coon Rapids, MN 55433.

What is your first name?

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* 1. What is your first name?

What is your last name?

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* 2. What is your last name?

At what email address would you like to be contacted?

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* 3. At what email address would you like to be contacted?

At what phone number would you like to be contacted?

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* 4. At what phone number would you like to be contacted?

How did you hear about this event?

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* 5. How did you hear about this event?

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