ADRC Event Signups

Signup for Event:

ZHealthy Living with Diabetes - November 6-December 11, 2017 12:30-3:00pm

Location: Grace Lutheran Church, 202 W Grand Ave. Eau Claire.

Please fill in the information below and choose payment option. Thank you
(* fields are required)

   Last Name*:

Address*: City, State, Zip*:

Phone*:    Email:

How did you hear about the event?
Website Facebook Flyer Friend ADRC Newsletter
ADRC Employee TV Radio Newspaper Other

Accomodations requested?
Yes No  
 (If yes, someone from ADRC will contact you)

Would you like to be added to our e-newsletter list to learn about upcoming events?
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Would you like to add family members?  (You can add up to 5 and will enter their names on the next screen)