Steps to Better Health Course Notification Steps to Better Health Course Notification Submit your upcoming CDSMP, DSMP, CPSMP, and/or Walk With Ease courses. Program Name*Living a Healthy Life (CDSMP)Living a Healthy Life with Diabetes (DSMP)Walk With Ease-GroupLiving a Healthy Life with Chronic Pain (CPSMP)Select one program type from the drop down list. If your program has a branded name other than what is listed, please include the name in the Notes/Special Instructions box at the bottom of this form.Workshop Location Name* Workshop Location Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Private Workshop?* Yes No Should this workshop be hidden from public registration and searches? Contact Phone Number for Registration/Questions*Contact Email for Registration/Questions* Workshop Cost? How much do participants need to pay for this workshop? Leave blank if free.Participant Registration LimitThis is the maximum number of participants that can register from the public workshop search or Physician Referral method.Leader 1 Name* First Last Leader 2 Name First Last Leader 3 Name First Last Will you be offering a session zero (for self-management programs)? Yes No Do not include the date of the session zero in your course start date.Start Date of Workshop* Month Day Year Enter the date of the first workshop sessionWhat day(s) of the week is your workshop to be held?* Sunday Monday Tuesday Wednesday Thursday Friday Saturday CDSMP, DSMP, CPSMP each meet one day per week WWE-Group meets three days per weekPlease list any dates that the schedule will differ (e.g. holiday, community center closed, etc) Workshop Start Time* : Hours Minutes AM PM AM/PM All CDSMP, DSMP, CPSMP workshops run for 2.5 hours from the start time. All WWE-Group workshops run for 1 hour from the start time.Special Instructions/Additional Workshop InformationCould include: Room meeting in, parking instructions, dates not meeting for holidays, different name for workshop, additional leaders, etc.Is this class being offered with support from MA4/an Area Agency on Aging (ACL CDSME funds)?* Yes No Who is your Regional Arthritis Center contact?*Northwest RAC (Debbie)Northeast RAC (Doris)Kansas City Area RAC (Orvie)Central RAC (Beth)Eastern/Greater St. Louis RAC (Duana)Southwest RAC (Heather)Southeast RAC (Becky)Click here to view the RAC Map by County
