URMC / Family Medicine / Mindful Practice / Curricula and Instructional Materials / Student and Resident Programs / Registration Payment Form

Mindful Practice Program Online Payment Form

*Chapin Mill Retreat Center - COVID-19 Vaccination - Attestation Required: I understand that the event location (Chapin Mill Retreat Center) will not permit entry to any attendee who is not fully vaccinated (~a minimum of two weeks post final vaccination shot). I understand and agree to provide proof of vaccination either prior to, or the day of the event. I understand that no refund will be given if I do not satisfy this requirement and acknowledge that the University of Rochester is relying upon my representation that I am fully vaccinated.

First Name *

Last Name *

The first and last names will be used in the CE certificate and billing information.

Email Address *

Verify Email Address *

The registration confirmation will be sent to this email.

Age Range

Gender

Profession

← to enter value select 'Other'

Institutional Affiliation

← to enter value select 'Other'

Name of Institutional Affiliation

Mobile Number *

Check if you are Student/Resident

Check if you are registering with a group of 4 or more or you were referred from the Gold Foundation or Centrum voor Mindfulness (Netherlands)

Check if we provided you with a special registration code

Manual

Mindful Practice Manual as PDF$285.00 per Manual. Number of Manuals =

$285.00

$0.00

Mindful Practice Program Online Payment Form

Total: $0.00