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My age is	under 20 21-30 31-40 41-60 61 or older
When it comes to wellness, I am a	participant patient student professional
I am especially interested in patient programs about	Cancer Heart Disease Chronic Lung Disease Asthma Diabetes Weight Management Stress Reduction
I would be interested in participating in your programs
I wish to be placed on your mailing list
I wish to receive information about your conference
My preference for contact is	email phone fax regular mail
I heard about the Mind-Body Wellness Center through	word of mouth newspaper radio television lectures or presentations browsing the web
I have a specific question (please state)

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Thank you for taking time to complete our survey