Tai Chi for Better SLEEP

Register Online

Required fields are indicated with an asterisk (*)

Registrant Information

* First Name

* Last Name

Pronouns

* Address

Addt'l Address

* City

* State

* Country

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

Registration

Physical Activity Disclaimer

By checking the box below, I have read and acknowledged the following statement - "You are not required to do any of these exercises, however I strongly encourage that you try, as long as you are comfortable. If at any time you feel pain or dizziness please stop immediately and let me know. Finally, if you plan to start a more vigorous exercise plan please make sure to consult your doctor first. Now LET’s GET ACTIVE!”

* I have read and understand this statement

* I would like to register for this Online Tai Chi for Better SLEEP class.

I have watched the orientation video on the registration page * Yes No

Orientation video can be viewed by copying this link into your browser: https://mediaspace.msu.edu/media/t/1_ziryevlo

Emergency Contact Information

In case of an emergency, please provide an emergency contact person we can call if you show signs of an emergency.

* First Name

* Last Name

* Phone Number

Allergy Acknowledgement

The instructor has a severe mint allergy. Exposure can result in anaphylactic shock. This includes mint gum, candies, menthol, menthol muscle creams, mint essential oil, and menthol cough drops.

* I agree not to wear or bring any mint products to class.

Contact Information

For more information or questions, contact Nicole Wethington at wethingn@msu.edu.