2. 
6. First Name*
7. Last Name*
8. How did you hear about this program?*

   1. Facebook
   2. Twitter
   3. Tumblr
   4. Library Website

   1. Email
   2. Word of mouth
   3. Public posting / Flyer
   4. Media
10. Creating Art Through Touch For The Vision Impaired*

    Choose the dates you wish to attend

    1. May 2, 2023
    2. June 20, 2023
    3. July 18, 2023
    4. August 15, 2023
    5. September 19, 2023
    6. October 17, 2023
    7. November 21, 2023
    8. I want to attend all sessions.
    9. None
12. SEMINARS*

    Choose the dates you wish to attend.

    1. April 11, 2023| Glaucoma Seminar for Seniors
    2. April 25, 2023| Preventing Falls for Seniors
    3. June 13, 2023| Armchair Travel - Stockholm
    4. July 11, 2023| Armchair Travel – Ireland
    5. August 8, 2023| Armchair Travel – Yosemite
    6. August 29, 2023| Armchair Travel – Yellowstone National Park
    7. September 12, 2023| Recognizing and Preventing Caregiver Strain
    8. September 26, 2023| Housing Options for Seniors
    9. October 10, 2023| Staying Safe at Home as We Age
    10. October 31, 2023| Disability Planning: Power of Attorney & Healthcare Representative Clinic
    11. November 14, 2023| Cataract Seminar for Seniors
    12. November 28, 2023| How to Administer an Estate
    13. December 12, 2023| Neurographic Art – A Form of Art Therapy
    14. I want to attend all sessions.
    15. None
14. How many people will you be registering?
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15. Please list the names of registrants other than yourself.
17. Zip Code
19. Contact Info
21. Library card #
23. Phone*
24. Email
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