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New Class Request

Fields marked with * are required.

Your Contact Information

* Your Name:

* Your E-mail:

* Your Phone:

Class Information

* Class Name:

* Class Description:

* Class Location:

Class Presenter:

Class Cost:

* Class Dates and Times:

* Class Length:

* How many seats are available?

* Would you like a waitlist created if the class is full?

yes no

Letter, flyer or directions to be mailed? If so, please explain.

Who should receive rosters, and how can they be contacted?

* How often would you like updates on the number of participants in your class?

* What are the types of advertisement for the class?

* Class Sponsor/Organizer:

Duke Health (DUHS, Duke Hospital, etc.)
Duke Raleigh Hospital
Durham Regional Hospital

Subject: