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2. Stepping On is a seven-week workshop using adult education to develop the knowledge and skills needed to help older adults prevent falls. It focuses on how strength and balancing exercises, medication management, home safety, footwear, vision, and mobility all play an important role in fall prevention.
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone number*
16. Email
18. How did you hear about this workshop?*
20. Choose from the workshop dates listed below. If there are no specific dates listed below, please mark the best choice for you and we will contact you regarding the dates, times and locations to see if they work for you.
22. Workshop Dates*

    1. I would like to be contacted to join the class that starts March
    2. I would like to be contacted to join the class that starts in June
    3. I would like to be contacted to join the class that starts September
    4. I would like to be contacted to join a class that takes place west of the interstate
    5. I am interested in the Stepping On workshop but would like more information sent to me
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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