Name:


Address:


City:


State:


Zip:


Phone:
-

email:


How did you hear about Coping Well? Adventures Within website Flyer at Denver Yoga Flyer at MS Hydrotherapy Flyer at RMMSC Hilltop Massage website The Heuga Center website Internet search engine MS Connection newsletter MSWorld website National MS Society Word of Mouth Other

If 'other' please list here:


Which session(s) are you registering for?
*Keep in mind, selecting a passed month will register you for NEXT YEAR's month.

January
February
March
April
May
June
* July
* August
September
October
November
December
*Summer break includes July and August each year.

For people calling in, please write down the phone number from where you will be calling:
-

I want to participate on-site

Method of Payment:
Cash Check Credit Card

Cash or check should be mailed 14 days in advance of each program to Coping Well, 316 Dexter Street, Denver, CO 80220-5658. Checks should be made out to Coping Well.