Addison Wellness Expo 2012 Participation Details

Participant Survey

Comments or questions are welcome.

*(denotes required field)

Name: *

E-Mail Address: *

I like the idea of a Gift Basket Raffle

Yes
No

I would prefer to donate _________ to purchase items for the gift basket

Money
Water Bottle
Pedometer
Tape Measure
DVD
Cookbook
Book
Other

Please describe what you wish to contribute toward the gift basket:

Time slots will be selected on a first come-first served basis. Please let us know what is most convenient for you and we will do our best to accommodate your needs.

My First Choice Time Slot (Day & Time between 11 AM & 6 PM) is:

My Second Choice Time Slot (Day & Time between 11 AM & 6 PM) is:

My Third Choice Time Slot (Day & Time between 11 AM & 6 PM) is:

My Fourth Choice Time Slot (Day & Time between 11 AM & 6 PM) is:

I am NOT available at the following day/time:

CAPTCHA Code: *

Download the Project Proposal

If you wish to have your own company listing published in the Program Guide, please provide the following information prior to February 27, 2012. The $15 listing fee must also be paid by February 27th.

The payment option shown on this page is via PayPal. Payment can also be made directly to DFW Health Coaches. Please contact me to make arrangements to pay via cash, check or credit card (by phone).

Thank you,

Ruthie

*(denotes required field)

Name: *

E-Mail Address: *

BUSINESS NAME *

CONTACT NAME *

PHONE # *

 

DESCRIPTION - SIX WORDS OR LESS:

Description Line 1 *

Description Line 2

CAPTCHA Code: *