Community Wellness Center Program Request

We are delighted to host groups focused on enhancing the wellness of our community of staff, patients, their families, and our neighbors. Please check our calendar of currently scheduled events to see if there are dates available for your program.
In order to ensure that the Community Wellness Center provides programs in a way that is consistent with our mission, we request that you provide the following information:
Name * Email * Phone*
Activity/Program Title*
Activity Program Description

Facilitator/Speaker Name(s)*
Presenter Bio(s)

Duration*  One Day Event Series
Start Date* - Month 123456789101112 Date 12345678910111213141516171819202122232425262728293031 Year 201120122013201420152016201720182019202020212022202320242025
End Date* - Month 123456789101112 Date 12345678910111213141516171819202122232425262728293031 Year 201120122013201420152016201720182019202020212022202320242025
Day(s)*  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time: Hour123456789101112:Minute00153045 AMPM End Time: Hour123456789101112:Minute00153045 AMPM
Anticipated Number of Participants*
Registration  Drop-in Group Pre-Registration Required
Registration Eligibility Requirements

Audio/Visual/Equipment Needs

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