To register for classes, please complete the information below so that we can process your request.

If you need help signing up for a class, or are having trouble with the online form, Contact Us or call the Customer Care Center at the phone number on the back of your Member ID card.

Name *
Member Number *
Mailing Address *
City *
State *
Zip *
Phone * Format: 123-123-1234 or (123) 123-1234
Email *
How did you hear about Rochester
Wellness Programs?

Are you a NEW participant of Rochester, NY Wellness Center programs? Yes No

Fill in program name and code below (use the date if no # is given)
Program Name

Program Code   
ex: ABCD 12345

Additional Comments/Suggestions