Fill out the form below to register online. Remember the Program Cost is $20.00. All payments will be collected at the program site.

Date/Time:*	02/09/09 - 5:30-9:30pm - Southview Hospital 03/02/09 - 5:30-9:30pm - Southview Hospital 05/18/09 - 5:30-9:30pm - Eaton High School
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All information gathered from this form will only be used by Kettering Health Network and not sold to or used by any third party.			*Required Fields