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REGISTRATION FORM

MindSET Reboot

Billing Information

Hospital/Organization/Business

First Name

Last Name

Hospital/Organization/Business Address

Hospital/Organization/Business Address 2

City

State

Zip Code

Phone Number

Email Address

Registration Information

RWHC Member & Affiliate Member

$110.00 per participant

Non-RWHC Member

$130.00 per participant

Cancellation Policy: Cancellations received up to two weeks prior to a program will receive a full refund, less a $25 processing fee. No refunds will be given for cancellations received less than two weeks prior to the program. Substitutions are accepted.

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This event has already occurred and is not accepting any additional registrations.