Mindfulness Community Collaboration Camp Registration 2024
We are thrilled to welcome you to Mindful Community Collaboration Camp! By completing the form below, you will be registered to participate assuming available space. 
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Email *
First Name
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Last Name
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Address
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Phone
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Emergency Contact Name and Phone Number
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Lodging & Programming Passes include breakfast, snack/coffee bar, lunch,  happy hour, dinner, and S'mores. Check in at 2pm and Check out at 10am. Book early- only 20 rooms available!  (Multi-night and programming discount included:)
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Which nights will you be staying? Click all that apply
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Required
I am not spending the night. I would like to buy a day pass for programming including snack/coffee bar, lunch & happy hour. Please buy early - there are only 20 Day Passes per day!
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Which days of programming do you plan to attend?
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Required
I would like to add a meal before or after programming
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Are you interested in Iowa or Nebraska CEU's (Continuing Education Units) or MCLE's (Attorneys- provide your bar #)? If so, which programs?
If not - put NA
(It is our understanding that Nebraska is self reporting for CEU's, we will make an application for Iowa pre-approval)
Please share your roommate choice if any, dates for extra meals and/or meal preferences, or anything else you would like to share with us.
Would you like to request financial assistance? Yes, I will add my earnest participation and share my practice with the community. I can afford to pay the following amount $_____
Are you willing to host our student interns, residents in training, and facilitators? Yes, I am adding the following donation  $_____
Hosting donations will be matched up to $3,000 by the Weiner/Skeen families, so please be generous and double your gift!
My proposed total contribution equals  $_____. After you hit the SUBMIT button on this form, please use the donate button on our WisdomHouseOmaha.org website to pay your offered amount or contact Aweiner@akclaw.com to discuss alternative payment methods *
A copy of your responses will be emailed to the address you provided.
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