2023 Application RISHI's Tending the Flame Retreat Workshop

1. Name and Education History *This question is required.

First Name
Last Name
Preferred First Name
Advanced Degree
School
Year of Graduation
License #
State of Issue

2. Professional Specialty *This question is required.

3. Professional Institution or Affiliation *This question is required.

Institution/Affiliation
Title
Professional Role
Years in Position

Professional Position (if more than one held concurrently)

Institution
Title
Professional Role
Years in Position

4. Contact Information

Address
City, State, Zip
Country
Cell Phone
Email

5. Are you a member of a resident, physician, or nurse wellness program, or an employee of one of these programs? If so, what is your role?

6. Do you have any experience leading small groups or workshops? *This question is required.

7. Do you have interest in starting a RISHI Finding Meaning Group in your community or institution? *This question is required.

8. How did you learn about RISHI's educational programming? *This question is required.

9. Please share one reason you are interested in attending RISHI's Tending the Flame Retreat Workshop.

10. Do you have any health care or dietary needs that our staff should know about? Please describe.

11. Is there anything else you would like us to know?

Continuing education credits for this workshop will be forthcoming.

CANCELLATION & REFUND POLICY: A deposit of $300 is due at time that your application is accepted. The balance is due by April 15, 2024. A full refund (less processing fee of $25) will be issued for cancellations on or BEFORE Apr 1. Cancellations after Apr 1 will forfeit deposit and/or registration fee.

2023 Application RISHI's Tending the Flame Retreat Workshop

2023 Application - RISHI's Tending the Flame Retreat Workshop