Seminar Registration Form

Please complete the following form in order to register for a free, educational seminar at Columbia. Attending this seminar is the first step in the bariatric surgery process.

After submitting your information, you will receive a confirmation email. If you do not receive this email in a few minutes, please check your junk folder.

Required fields (*)

Contact Info

(e.g. NJ) -- (with area code)
-- (with area code)
-- (with area code)


Additional Information

Years Old





Feet Inches

Lbs (round to the nearest whole number)







Select the Seminar You Would Like to Attend