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Registration request for Cooking Class

Thank you for your interest in this event/program. Please complete and submit the form below.

Timeslot:

Friday 15th Nov 2019, 1:00pm - 3:00pm

Location:

HIllsburgh Wellington Cty Library
9 Station Street Hillsburgh ON

Availability:

6 spaces remaining

Full Legal Name:

Date of Birth:

Email:

Confirm email:

Phone Number:

Are you enrolled with one of our physicians?

How did you hear about this program?

Message:

By clicking "Submit", you agree to send this personal information to East Wellington Family Health Team online.

You agree to the Privacy Policy, which governs how your personal information is kept safe.