Brain Games: Fun for Seniors Every 1st and 3rd Monday starting at 10:00 AM at the Schmieding Center Each participant must register "*" indicates required fields Enter required information below. * Required First Last Email * Required Phone * RequiredResidence County * RequiredBentonWashingtonMadisonBaxterBooneCarrollIzardMarionNewtonSearcyStoneotherZip Code * Required 5 digits only Gender * RequiredMaleFemaleOtherRace * RequiredAfrican-AmericanAmerican IndianAsian/Pacific IslanderCaucasianHispanicMiddle EasternOtherProfession * RequiredPublic/CommunityDieticianMedical StudentNursingNursing Home AdministrationParaprofessionalPatientPhysical TherapyPhysicianResidentSocial WorkStudentHow did you learn about this program?My Center on Aging (the Schmieding Center)FacebookWebsiteWord of MouthReferral by my healthcare providerOtherCONSENT TO USE MEDIA IMAGES FOR PROMOTIONS I hereby give the University of Arkansas for Medical Sciences, their legal representative, assigns, and those acting on their behalf and with their permission, the right and permission to copyright in any part of the world, to use, reuse, publish and republish, in conjunction with my own or fictitious name, any photograph, film or video tape recording taken of me by the University of Arkansas for Medical Sciences or those acting on their behalf or with their permission, and any reproductions thereof, in any form, whether intentional or otherwise, and may be used in conjunction with any advertising material, for any purposes of trade, advertising, exhibit, publicity, or promotion, without restriction or limitations. I understand that the photographs, film and/or video may be used in news releases, newspapers or magazine articles, television, the UAMS website or social media sites (e.g., Facebook , YouTube). I hereby release, discharge, and agree to save harmless the University of Arkansas for Medical Sciences, their assigns, legal representatives, agents, and those acting on their behalf and with their permission, from and against any liability resulting from any distortion, blurring, alteration or use in composite form, whether such was intentional or otherwise, which my occur, result, or be produced in the taking of said photography, or by processing or reproduction of the finished product, its publication or the distribution of same. I waive the right to approve or inspect the recordings, advertising copy, or material used in conjunction therewith.This field is hidden when viewing the formI consent, per above terms, to the use of my image by UAMS for program and event promotion * Required Yes No This field is hidden when viewing the formI want to receive email notice about other Schmieding Center events * Required Yes No