Registration Tai Chi Chih Class - MCISG members - Registration Personal Information Event Date* - Select Event Date - February 19, 2019 - 6:00pm February 26, 2019 - 6:00pm March 5, 2019 - 6:00pm March 12, 2019 - 6:00pm March 19, 2019 - 6:00pm * Required First Name* Last Name* * Required Address* * Required Address 2 City* * Required State* Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana International Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming * Required Zip Code* * Required Email Address* * Required Phone* * Required Invalid Phone Number Alt Phone Invalid Phone Number Gender MaleFemale How Did You Hear About Us?* Select Internet Search From a Friend Healthcare provider Feeling Great Quarterly News From a Caregiver From Newspaper Other * Required Secure Payment Information Billing Address* * Required City* * Required State* Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana International Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming * Required Zip Code* * Required Name On Card* * Required Credit Card Type* Select Visa MasterCard American Express * Required Credit Card Number* * Required Invalid Credit Card Expiration Date* 010203040506070809101112/2019202020212022202320242025202620272028202920302031203220332034 Invalid Expiration Date Security Code* * Required Total $25.00 Register Find A Doctor Find a physician who is right for you. Search Physician Directory