Self-Care Institute Scholarship Entry Form

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Self-Care Institute Scholarship Entry Form

Completing this form enters you into a drawing for a scholarship to attend the “Resilience over Burnout: A Self Care Program” presented by Ami Kunimura, MA, MT-BC, founder of The Self-Care Institute. You must be a registered member of BMTN to qualify. Please visit our website at https://www.blackmtnetwork.org/ to register before completing this form. Thank you!

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Email *

Your email

Name (First, Last) *

Your answer

Phone number

Your answer

Are you a current member of BMTN? *

Yes

No

A copy of your responses will be emailed to the address you provided.

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