UHS Walk-In Mammography Event Registration

Tuesday, Nov. 14

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Date of Birth (Required.)

Please select your date of birth.

Date

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4. Date of last mammogram (must be prior to November 14, 2022)

Skip this question if no prior mammogram.

Date / Time

Date

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5. Phone Number (Required.)

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6. Email Address (Required.)