Online Tai Chi for Fall Prevention

Register Online

Required fields are indicated with an asterisk (*)

Registrant Information

* First name

* Last Name

* Address

Addt'l Address

* City

* State

* Country

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

Registration

Physical Activity Disclaimer

By checking the box below, I have read and acknowledged the following statement - "You are not required to do any of these exercises, however I strongly encourage that you try, as long as you are comfortable. If at any time you feel pain or dizziness please stop immediately and let me know. Finally, if you plan to start a more vigorous exercise plan please make sure to consult your doctor first. Now LET’s GET ACTIVE!”

* I have read and understand this statement

* I would like to register for this Online Fall Prevention class.

* Birth Year Enter a whole number greater than or equal to 0.

Emergency Contact Information

In case of an emergency, please provide an emergency contact person we can call if you show signs of an emergency.

* First Name

* Last Name

* Phone Number

Contact Information

For more information or questions, contact Jacqui Rabine at rabineja@msu.edu.