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2. 
3. 
   ONLINE REGISTATION
5. First Name*
6. Last Name*
8. Date of Birth*
9. Age*
11. Email Address*
13. Address1
15. Address2
17. City
18. State
19. Zip
21. Have you ever attended an In-Person Matter of Balance class?*

    1. Yes
    2. No
23. Dates of Matter of Balance Zoom Meetings
    Tuesday   01/26/21  Introduction to the Program
    Thursday 01/28/21  Exploring Thoughts and Concerns About Falling
    Tuesday:  02/02/21  Exercise and Fall Prevention
    Thursday 02/04/21  Assertiveness and Fall Prevention
    Tuesday:  02/09/21  Managing Concerns About Falling
    Thursday 02/11/21  Recognizing Fall-ty Habits
    Tuesday:  02/16/21  Recognizing Fall Hazards in the Home and Community
    Thursday 02/18/21  Practicing No Fall-ty Habits - Fall Prevention: Putting it All Together
25. Once you have submitted this form to sign-up, we will send you a confirmation email to let you know that you have been registered.
    
    Once you are registered, you will receive another email that includes the links and codes that are needed to access our zoom meetings and the above designated meeting dates.
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26. Submit

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