People's Medical College

Registration Details:

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Name:*
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City:*
State:*
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Phone AM:*
Phone PM:
Email:*

Preferred method of contact:*

EmailTelephoneLetter

Please define your age range (this helps us better define our program content):*

18-3031-5051-7071 and above

Seminars: (select the seminars you would like to attend below)*

	Event	Date	Start Time	End Time	Hospital	Availability
	Cardiovascular Disease: Fact or Fiction	2012-02-25			Sinai-Grace Hospital	Available
	Super Foods that Boost Kidney Health	2012-03-31			Sinai-Grace Hospital	Available
	Putting the Pep Back in Your Step	2012-04-28			Sinai-Grace Hospital	Available
	Relief for Spine and Back Pain	2012-05-19			Sinai Grace Hospital	Available

Survey Detail:

1. How did you hear about People's Medical College?*

WebFriend/RelativeRadioDirect MailNewspaper

2. Are you interested in future People's Medical College Programs?*

YesNo

3. Would you like to be added to our email list for future updates?*

YesNo

4. Have you ever used a DMC facility for any of your healthcare needs?*

YesNoI don't know

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*Type Security Code:

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