CALM Workshop

Weekly Workshop: CALM

Our weekly CALM workshop is held most Tuesdays at 11am in our conference room (3611 River Road, Ste 200, Yakima, WA 98902). Please have each person who is planning on attending submit a separate form so we can plan accordingly. Thank you!
Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Which CALM workshop(s) are you attending? (select all that apply)*

Tuesday, December 10 @ 11amTuesday, December 17 @ 11amTuesday, January 7 @ 11amTuesday, January 14 @ 11amTuesday, January 21 @ 11amTuesday, January 28 @ 11amTuesday, February 4 @ 11am
Are you a current member with Assurance Healthcare & Counseling Center?*

YesNoI'm not sure
By clicking the submit button below, you agree to have the above information sent securely via this HIPAA compliant form to another third-party application managed by Assurance Healthcare & Counseling Center where private data is securely stored. Any identifying PHI (protected health information) will not be transmitted via email or any other insecure format.
Should be Empty:

Weekly Workshop: CALM