PFBL Class Update Form

Please complete this form for each of your Arthritis Foundation Programs for Better Living classes that you lead.
* required information
Contact 
Contact Information
First Name:*
Last Name:*
Company Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Fax:
Cell Phone:
What type of PFBL Class are you teaching?:*
Facility Name:*
Facility Address:*
Facility City:*
Facility State:*
Facility Zip:*
Facility County:
What days of the week do you meet?:* Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time is the class? (Example: 10:30-11:30am):*
Beginning Date of Class:*(mm/dd/yyyy)
Ongoing?:* Yes
No
If no, please enter the end date:(mm/dd/yyyy)
Additional Information that needs to be included in the program listing?:
Phone number to contact for more information about the class:*
        

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