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First name
Last name
Email
Phone
1. Do you have a condition that places you at risk for injury during exercise?
*
Choose one
2. If YES please explain so that we can best try to accommodate your needs, if NO please answer N/A.
*
3. This virtual event will include a prayer for mental wellness, a mother's story about her late son with a mental illness, and a Gospel chair workout. Being made aware of this will you still register for the event?
Yes
No
4. Please share your age.
*
5. What city and state do you reside in?
*
6. What do you do currently to stay mentally well?
*
By participating in this event, you acknowledge your involvement is voluntary. MAB Wellness Outreach and its affiliates are not liable for any injury, or harm that may occur. We don't provide diagnoses or medical advice. I understand all presented.
Yes
No
If you will be doing an offline donation payment of Cash App or Zelle please submit this form and remit this tax-deductible amount by mobile or phone. Donation request: $5. Donations of $10, $15, $20 and $30 are welcome. Please inform if Cash App or Zelle
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