MBSI Consulting Request Form

Organization *

First Name *

Last Name

Job Title *

Email *

Phone *

Address

City

State/Province

Zip

Type of service requested:

Wellness Workshop

Panel Talk

Yoga/Meditation/Mindfulness

Consulting

Wellness Program Development

Coaching

Other (please specify in additional comments below)

Please specify

Goals/Outcomes (Please briefly describe what challenges you are facing and the desired outcomes you would like to see).

Proposed Date(s) or Timeline

Budget (if applicable)

Estimated Number of Participants

Additional Comments

How did you hear about us?

If you have additional questions, please reach out to mbsi@junghouston.org

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