Welcome to the Network for a Healthy California--Bay Area Region Website

Bay Area Region :: Meeting Registration

What: 7th Annual Physical Activity & Nutrition Forum Showcase

When: Tuesday, June 5, 2012, 9:30 AM - 2:30 PM

Where: Locatelli Center • Santa Clara University, 500 El Camino Real, Santa Clara 95050

Presented by: The Network for a Healthy California-- Bay Area Region in partnership with
The American Diabetes Association, Santa Clara Public Health Department & Santa Clara University

Please complete registration form below for EACH participant:
(Register each participant separately.)
Please note that ALL fields are required to submit registration.

First Name:
Last Name:
Title:	If no title, please type in SELF.
Organization:	If no organization, please type in NONE.
Address:
Phone:
Fax:	If you do not have a fax, please enter 000-000-0000.
E-mail:

Do you serve the following groups: (Check all that apply.)
	Schools with 50% or more free and reduced lunch
	Individuals eligible for CalFesh, funded by USDA SNAP (Supplemental Nutrition Assistance Program)
	Medically uninsured or under-insured individuals

A Grab 'N Go working lunch will be provided. Please check if you would like a:
	Vegetarian Lunch

Would you be willing to participate in a physical activity and nutrition community intervention in 2013:
	YES

Would you be willing to serve on a planning committee for a physical activity and nutrition community intervention in 2013?
	YES

two contacts
( indicates link available)

Carmen Bogan, MBA
Physical Activity Coordinator
Network for a Healthy California-- Bay Area Region

E-mail Carmen Bogan
Tel: 510.482.8827, ext 2
Fax: 510.531.2076

OR

E-mail Suellen Haggerty
Tel: 408.793.2719