UAB Generations Membership Registration



Generations is a comprehensive program dedicated to the health care of women of all ages. Developed by the UAB Health System, Generations' goal is to offer support throughout the many phases of a woman's life.

To enroll, please complete the membership form:

Required fields are marked with * below.
Salutation:
 Mr. Ms. Mrs. Miss
First Name: *
Last Name: *
Address: *
City: *
State: *
ZIP Code: *
Gender: *
Date of Birth: *


E-mail Address:
Email Format: Text / Don't Know HTML

I would like to receive a health e-newsletter via e-mail:

Yes No


Are you a UAB Health System Employee?
Yes No

If yes, which facility?

Are you currently a patient of the UAB Health System?
Yes No

Which Generations lifestyle category most applies to you now:

Parenting
Obstetrics
Working woman
Mid-life health
Active retirement

I would like to receive ongoing updates on these health topics:
(check all that apply)

Allergies
Alzheimer's disease
Arthritis
Blood pressure
Cancer
Diabetes
Headaches
Heart disease
Incontinence
Menopause
Osteoporosis
Stroke
Weight management / Nutrition

Other:

I would be interested in attending women's health screenings and events:
No Yes






This offer valid with respect to individuals interested in the Generations program as determined in the UAB Health System's sole discretion.

Privacy Policy and Use of Personal Information:

All personal information you provide to the UAB Health System Web Site is kept confidential. The Health System will not sell, rent, or release your name, e-mail address or other personal information you provide. The personal information you provide will be used to better understand the interests and opinions of groups or segments of people within the healthcare market and enable the Health System to provide you with current healthcare information based on your interests.

HS04: Master Img Health System
UAB Health System