MINDSTRONG / MINDBODYSTRONG Registration Form
Business Information
Are you affiliated with The Ohio State University? *
Organization *
Organization State *
Organization City *
Organization Zip *
Are you registering more than one person in your organization? *
MINDSTRONG / MINDBODYSTRONG Information
Are you interested in registering for a MINDSTRONG™ or MINDBODYSTRONG™ facilitator training? *

The total cost to register for facilitator training is $700.00 per person. This includes training and access to an electronic non-printable encrypted manual. All registered participants will receive an email prior to their training date with a link to access the training PowerPoint deck along with access to this electronic manual. If you would like to also receive a hard copy of the manual, there will be an additional fee of $75.00 plus shipping per manual. Please indicate your preference below.

Note: If you are an Ohio State affiliate, you may be eligible to register at no cost, or at reduced cost. Once this form is submitted, a MINDSTRONG / MINDBODYSTRONG administrator will follow up via email to provide confirmation of fees, if applicable.

*

Additional Notes
OSU Affiliation
OSU Classification
OSU Name.#
Registrant Information
Professional Title
Professional Expertise
First Name
Last Name
Phone
Email
Healthcare License / Credentials (if applicable)
Shipping Information
Attention (First and Last Name)
Address 1
Address 2
City
State
Zip
* Required field(s)
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