Valley Mindfulness -- Registration Form

Registration

To register, please complete the following form.

The Orientation session is free of charge.

Please note that payment for an MBSR course is not required prior to attending an Orientation session.

At the conclusion of the Orientation session, either a $150 deposit or the full program fee is required to reserve a space in the program.

Space is limited. Please do not register for an Orientation session unless you are definitely planning to attend.

Program sessions (choose one):

March 5 Orientation Session for
Mindfulness-Based Stress Reduction
8-week cours: Monday evenings March 19 - May 7, 2012, 6:00 - 8:30 pm. All Day class Saturday, April 28, 2012, 9:00 am - 4:30 pm.

The Orientation session is free of charge.
The full 8-week MBSR course costs $350–$550 — we offer a sliding scale based on income (see program page for details and contact us if you have questions).

March 12 Orientation Session for
Mindfulness-Based Stress Reduction
8-week course: Monday evenings March 19 - May 7, 2012, 6:00 - 8:30 pm. All Day class Saturday, April 28, 2012, 9:00 am - 4:30 pm.

Any fields marked with * are must be filled in.

First Name*:

Last Name*:

Mailing Address*:

City*, State*:

Zip Code*

Email Address*:

Daytime Phone*:

Evening/Weekend Phone:

How did you learn about the Mindfulness-Based Stress Reduction program?*
(For example, the person you were referred by or the publication where you saw an advertisement.)

What do you hope to learn or gain from taking the Mindfulness-Based Stress Reduction program*?
Please be specific.

Some quotes from recent workshop participants:

"The instructor was very detailed and extremely knowledgeable. Very professional."

"Definitely inspires me to try to start a mindfulness practice."

"I enjoyed the afternoon very much — came with little expectations, just curiosity. Was surprised at my ability to get into a strong meditative state. David was lovely, soothing and clear with ideas and instructions."