Munson Health
 
Zumba Form 3

  
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First Name
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Last Name
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Employee Number
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Email Address
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Contact Number
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Family members of employees may attend. If you wish to sign up a family member to attend with you, please provide their name:
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Two sign-up options

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I hereby authorize Munson Medical Center to deduct from my paycheck $45.00 (please type your name in the box below to serve as your electronic signature).
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What is your Zumba level?



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Please provide any additional information on your Zumba level: