Seminar DetailsDate and Time of Seminar*Seminar TitleSurgical Weight Loss Seminar- Hosted by Metro HealthSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss Seminar- Hosted by Saint Mary’sSurgical Weight Loss SeminarSurgical Weight Loss Seminar- Hosted by Saint Mary’sSurgical Weight Loss SeminarSurgical Weight Loss SeminarSurgical Weight Loss SeminarLocationMetro Health Professional Building (Grand Conference Room)- 2122 Health Drive, Wyoming, MI 49519 (turn east off Byron Center Ave. onto Health Dr., go past Main St. and turn right into driveway to the Professional Building.)Northern Michigan Urology/Grand Health Partners 405 N Division Road, Suite #2 Petoskey, MI 49770Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Northern Michigan Urology/Grand Health Partners 405 N Division Road, Suite #2 Petoskey, MI 49770Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Grand Health Partners 2060 East Paris Ave SE STE 100 Grand Rapids, MI 49546Northern Michigan Urology/Grand Health Partners 405 N Division Road, Suite #2 Petoskey, MI 49770Northern Michigan Urology/Grand Health Partners 405 N Division Road, Suite #2 Petoskey, MI 49770Patient InformationDate of Birth* MM slash DD slash YYYY First Name* Last Name* HeightFt In Weight Contact InformationAddress* Address 1 Address 2 City* State* Zip* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number* Email Address* Name of Insurance* Member ID* Group # Subscriber’s Name Subscriber’s DOB MM slash DD slash YYYY CAPTCHA
