Form – My College Wellness

A BETTER FUTURE STARTS NOW!

Select Program of Interest:

Zipcode

Do you possess a current and valid teaching license?

Yes

Do you possess a license as a registered nurse in the state where you are employed as an RN?

Yes

HS Grad Year

Level of education

First name

Last name

Phone number

Address

I certify that I am 18 years old or older. By clicking this box and submitting this form, I provide my electronic signature giving prior express written consent to be contacted by phone or recurring text messages, including at my wireless number if provided, by a representative from My College Wellness and Alonzo Media regarding educational opportunities. This consent is given for the purposes of all federal and state telemarketing and Do-Not-Call laws, to market to me educational products and services, and for all other purposes. I understand that my telephone company may impose charges on me for these contacts. These calls or texts may be generated using automated technology. I understand that consent to be contacted is not a condition of registration. These calls may be placed using an automatic dialer and/or pre-recorded messages, and I am not required to provide this consent as a condition of purchase. I also understand that I will receive advertising via email to the email address I provided above from My College Wellness and Alonzo Media. I have read and accept the Privacy Policy.