STRONG-REGISTRATION

First Name*

Last Name*

Phone Number*

May we send you text messages?*

YesNo

Email Address*

Repeat Email Address*

How many people in your household are participating?*

Are you a Miami County Y Member?*

YesNo

Only Miami County Y members are eligible for a free shirt upon completion of the STRONG program.

Members - Select the shirt sizes your family needs, then indicate a count for each selected size

# of small shirts

# of medium shirts

# of large shirts

# of XL shirts

# of XXL shirts