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Gala Registration Form

To resgister please fill out this form

Health & Fitness 4 Minority Women, Inc. *

Buy your tickets online by pushing the "Pay now" button

Gala Registration Form

Name/Company's Name:


Contact Number:

Email Address:

Please check the appropriate box:

For Groups Please list the names of your members

Please enter the number of Persons

Please enter the amount registered:

For Checks Please mail your registration to:

Health & Fitness 4 Minority Women, Inc

Attn: Health Education/Prevention Programs

7118 Orral street, Oakland CA 94621

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