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REGISTRATION FORM
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Registration is required. Deadline to register is Friday, February 6, 2015. Space is limited, early registration is suggested.
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Name: _________________________________________________________________________________________________ Address: _______________________________________________________________________________________________ City: _____________________________________ State: _________________ Zip Code: _____________________________ Phone: ___________________________________ Alternate Phone: ______________________________________________ Email: __________________________________________________________________________________________________ Gender: Male Female
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To register:
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Questions? Contact Meri Tesfay (Mo) at 817-531-5600 or metesfay@tarrantcounty.com.
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Fax: (817) 531-5633 or e-mail a scanned copy to metesfay@tarrantcounty.com. You can also register online at http://healthylivesmatter.eventbrite.com.