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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?