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Affiliation *  
Please indicate your organizational affiliation in the box above.
Name *
Title
First Name
Last Name
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Job Title
Address *
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City
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Email *
Phone
General Registration  
x $85.00
Enter "1" Please register each individual separately.
Einstein Medical College Students  
Check here if you are a STUDENT registering to attend the two day Breath, Body, Mind Workshhop and enter your registration below.
Einstein Medical College Student Registration  
Enter "1" to register as an Einstein Medical College student,
Social Work CPE  
x $25.00
Enter "1" if requesting CE credits
CME Credits - Montefiore Health System only  
Please check if you are interested in receiving CME Credit for the 2 day Breath, Body, Mind workshop. The cost of CME Credits is covered by Montefiore.
NYS Library CE Credits  
Check here if you want to receive NYS Library CE Credits. WLS covers the cost of Library CE Credits.
Any Dietary Restrictions  
If you have any allergies we should know about please indicate here.
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