Registration Mindfulness-Based Stress Reduction Course Registration Please complete this Registration form: Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* How did you hear about us?*Select OneSearch Engine/AMI WebsiteSocial MediaPast Participant RecommendationAdvertisingOtherHow should we contact you?* Email Phone Course Start Date & Location*Select OneJanuary 10 - VirtualJanuary 7 - Atlanta (In person)Mindfulness-Based Stress Reduction Course FeeSupporter RateBase RateSubsidized RateTerms & Conditions: You are eligible for a full refund minus a $50.00 service fee until 14 days prior to the course start. If cancellation occurs within less than 14 days you are entitled to a 50% refund. Once the class begins there is no refund.* Yes, I agree to the Terms & Conditions I want to stay connected and be notified of new courses and opportunities. Sign me up for your email list Total $0.00 Once AMI receives course payment, participant will receive an email that includes a password to class resources. There will be three documents that the participant will need to download and return to AMI prior to the first class.