Get Healthy Registration Please register below for: Get Healthy Pas./So. Pas./Alta. Registration 2019 First Name*Last Name*Street Address*City*State*Zip Code*Email Phone*How did you hear about us?*On the internetFrom a friendFrom MEMAH flyerRadioOtherWhat is your Age Group?*Age 20 to 39Age 40 to 49Age 50 to 59Age 60 to 70 plusWhat time will you arrive?*8:30 am - 9:30 am9:30 am - 10:30 am10:30 am - 11:30 amPlease select FREE Health Screenings* Stroke Carotid Artery Prostate Diabetes Cholesterol High Blood Pressure Body Mass Index (BMI) Eye Care (Vision) Hearing Dental Lung HIV Other If you select 6 screenings, you will receive FREE Lunch!Enter any Questions, Comments, or FeedbackPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
