CLASS REGISTRATION:
Please fill in the following fields. The next
Empowered To Quit
classes will start in September, 2010 at The River Center in Lebanon, Oregon. The exact dates and times will be announced later.
The cost is $100.00, which includes a comprehensive manual and all the supplies used in the class.
Scholarships are available (on a sliding scale) for those who need this help.
Samaritan Health Employees, who qualify for Wellness Dollars, may use their Wellness Dollars to pay for this class.
There are two options for taking the class: (1) in a small group setting or (2) with individual counseling sessions.
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indicates required fields
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Name:
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Mailing address:
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Email:
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Phone:
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Best time to contact you:
9:00 to 11:00 am
12:00 noon to 4:00 pm
5:00 to 8:00 pm
Questions/Comments:
I will be using my Wellness Dollars for the class:
No
Yes
I need a Scholarship:
No
Yes
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Class Preference:
Small group setting
Individual counseling sessions
All the information you provide will be kept confidential. After registering for the class, you will be sent an email confirmation. If you desire to pay for the class today, you will be given the option of doing so on the following page.
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