YWC

Your Wellness Connection, P.A.
7410 Switzer
Shawnee Mission, KS 66203

Phone: (913) 962-7408
Toll Free: (888) 310-9355 (WELL)
Fax: (913) 962-7416

Class Registration:	* required field
*First Name
*Last Name
Street Address
City
State
Zip
*Home Phone
Alternate Phone
*Email Address
*Event Name
*Event Date (mm/dd/yr)
Are you bringing a friend?	Yes No
Friend's First Name
Friend's Last Name
How did you hear about this special event?
Are you a current client of Your Wellness Connection?	Yes No