Defeat PD Interest Form

Parkinson’s: Defeat PD

* Indicates required field

Full Name*

First Last

I am inquiring about Defeat PD for:*

Myself

A loved one

A friend

Registration is required for this class. Candidates must sign and return a digital welcome packet with intake forms that are completed online. Once received, one of our specialized trainers will perform a brief in-person movement assessment with each candidate at the YMCA.

Defeat PD is offered at multiple branches. Which location are you in interested in?*

Greystone YMCA (5414 US-280, Birmingham, AL 35242)

Hoover YMCA (2250 John Hawkins Parkway Hoover, AL 35244)

Mountain Brook YMCA (2401 20th Pl S, Mountain Brook, AL 35223)

Pelham YMCA (2610 Pelham Pkwy, Pelham, AL 35124)

I don’t have a preference.

Email Address for Reply*

Phone*

Preferred Method of Contact*

Participant DOB

Parkinson’s: Defeat PD

Find your
fitness at
the Y

Find your
friends at
the Y

YMCA of Greater Birmingham

DEFEAT PD Interest Form

Parkinson’s: Defeat PD

Find your fitness at the Y

Find your friends at the Y

YMCA of Greater Birmingham

Find your
fitness at
the Y

Find your
friends at
the Y