CANCELLED: Workshop: Equality Diversity and Inclusion

Terms & Conditions

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I confirm by ticking this box that I have read the course description and relevant information sheets and understand and agree to the Terms & Conditions of the Mindfulness Network.

About you

Title:
Forename:
Surname:
Address:
Town/City:
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Postcode:
Country:
Phone:
Email:

Please provide emergency contact details below:
Name of contact:
Relationship to you:
Phone number:

I am a Mindfulness Network Associate:

Where did you find out about this event?

Please provide further information:

Your Mindfulness experience and practice

Are you currently registered on the Teacher Training Pathway?

Please confirm which of the following courses you have completed

Eight-week MBCT/MBSR course

Date of completion:

CMRP/MN taught nine-week distance learning MBSR programme

Date of completion:

A mindfulness-based Teacher Training Retreat level 1 (TTR1) with CMRP

Date of completion:

Teaching 1 module on the CMRP Mindfulness-Based Master's Programme

Date of completion:

Alternative Teacher Training in Mindfulness based approaches

Please provide the name of the institution and date of completion:

Please list dates and locations of any mindfulness-based courses you have taught previously:

If you would like to provide any other information about your engagement with mindfulness, please do so here.

What is your professional role/work?

Course fees

Please select the fee that you're paying

Is your employer or a company/organisation paying your fee?

Recognising the administrative overhead of dealing with employers, we will be adding a £50 surcharge if the employer is paying directly; where possible we would recommend that applicants pay themselves and reclaim on expenses to avoid the charge. Responsibility for payment remains with the attendee. Please note: If your employer is paying, a deposit option will not be available, and the full amount will be invoiced.

Please tick to confirm you have read the above information

Please provide further details of where to send your invoice: Organisation name:

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Contact name:

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Do you have a purchase order number - if you are working within the NHS, this is usually necessary:

Your physical and mental health

It is helpful for us to have some information about you so that we can best meet your needs at the event. Please provide information, if possible, to the following questions:

Do you have any physical illness or other limitation that may make hearing, sitting, or standing difficult?

Please provide further information:

Please provide any other information you would like to pass onto the admin team or teachers in connection with this application. Please include any dietary requirement needs, if applicable to this event

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CANCELLED: Workshop: Equality Diversity and Inclusion

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