YMHFA Registration

Name(Required)

First Last

Email(Required)

Date of Birth(Required)

Phone(Required)

Organization/Business

(if applicable)

Position

(if applicable)

Please choose a class(Required)

Wednesday, Oct 16 | 9:30 am - 3:30 pm

Please let us know of any dietary restrictions:(Required)

Choose all that apply

No dietary restrictions

Vegetarian

Vegan

Pescetarian

Gluten-free

Dairy-free

Other

Please list other dietary restrictions:(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Youth MHFA Class Fee(Required)

Price:

Credit Card

Card Details

Cardholder Name

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