To register for a Matter of Balance, please complete the following survey.

LOCATION: OHSU Center for Health and Healing, 12th floor, room 12181
TIME: Tuesdays 10-12 AM
DATES: October 8, October 15, October 22, October 29, November 5, November 12, November 19, November 26

* 1. What is your first and last name?

* 2. What is your email address?

* 3. What is your mailing address?

* 4. What is your phone number?

* 5. What is your age?

* 6. What is your gender?

* 7. Will you be taking public transportation to the class at the Center for Health and Healing?

* 8. Will you be driving yourself to the class?

* 9. Were you referred by a medical person?

* 10. How did you learn of this class?

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