Aging Ahead Arnold 10-2-24

October 2, 2024

12:30 pm – 2:00 pm

Location: Jefferson College Arnold – 1687 Missouri State Road, Arnold, MO, 63010

Programming: Aging Ahead-Arnold gathers at Jefferson College Arnold on Mondays and Wednesdays from 12:30pm-2pm. Enjoy lunch and socialization with other older adults.

Registration: Lunch is provided free-of-charge to those adults age 60+ who preregister 72 hours in advanced with a suggested donation of $5.

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Name*

First Last

Email*

Phone*

Are you a CHOICE member?*

Yes, I am a CHOICE member.

No, I need to sign up for the free CHOICE program.

Check Yes, if you have already filled out our 10 questions like address, birthday, primary race, etc. Check No, if you need to answer these additional questions.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Birthdate (MM/DD/YYYY)*

Gender*

Ethnicity*

Primary Race*

Medicaid Eligible*

Rural*

Low Income*

Yes

Unknown

Use this chart to determine if you are low income - [1 in household: $1,040.83/month] [2 in household: $1,409.17/month] [3 in household: $1,777.50/month] [4 in household: $2,514.17/month]

Number in Household?*

Lunch Order

Lunch must be ordered 72 hours in advance, by Friday at 11:00am for Wednesday and Wednesday at 11:00am for Monday. We are unable to make changes to your meal order after registration. If you registered without ordering a lunch and would like to change that to a meal, please reregister with your meal order. We are unable to accommodate any changes made over the phone or by email. (Please note the program has a 5 lunch order minimum and lunches may not be available.)

Box Lunch Options (No Substitutions)*

Side Salad or Entrée Salad Dressing*

Milk*

Name

This field is for validation purposes and should be left unchanged.

Aging Ahead Arnold 10-2-24

Lunch Order

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