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2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Please select one.

   1. Lifestyle Medicine
   2. Diabetes Prevention Program
   3. Other
10. Number of people you are registering.*
12. Do you or any of those you are signing up have food allergies?*
14. If registering children, what are their ages?
16. Prepayment is required for all cooking classes. Payment will be refunded if a minimum is not met to hold a class or if you notify CHA two (2) business days prior to the actual class. Your registration is not complete until payment is received.
18. Which class(es) are you registering?*

    1. All classes are full at this time

    Check all that apply. If paying online, change the quantity of class to match the number of classes you have selected.

20. How will you be paying? *

    1. Mailing Payment (please make check payable to Cabarrus Health Alliance and envelope addressed to Attn: Emma Zelaya)
    2. Will drop payment off (include your information in envelope and drop off at front desk for Emma Zelaya)
    3. Paying Online (online payment will be located on the confirmation page after you submit registration)
22. If mailing payment please send to Cabarrus Health Alliance, Emma Zelaya, 300 Mooresville Road, Kannapolis, NC 28081
24. For questions or for more information please email CookingClass@CabarrusHealth.org or call 704-920-1301. Thank you!
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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