Valley Mindfulness -- Registration Form

Registration

Please complete the following form. After you submit this form, you will be directed to a page with instructions on how to send deposits and payments. You may pay by check and credit card.

Please note that payment (either a deposit or the full fee) is required to reserve a space in the courses and workshops.

If you have previously registered and wish to make a payment, click here for the payment page.

Program (check one—or more than one—as applicable):

	A Taste of Mindfulness September 2010 (dates to be announced soon), 6:00 pm to 8:00 pm. Cost is $25 if paid in advance. $30 if paid at the workshop. (Fee may be applied toward the cost of the Mindfulness-Based Stress Reduction course if taken within 9 months).

	Mindfulness-Based Stress Reduction 8-week course, September 2010, dates to be announced soon. Cost is $300–$550 sliding scale based on income (see program page for details and contact us if you have questions). A deposit of $150 is required to reserve a space.

	Private Sessions in Mindfulness-Based Stress Reduction and in ongoing support of Mindfulness practices. For individuals and groups. Cost is based on the number of participants and the number of sessions.

First Name:

Last Name:

Mailing Address:

City, State:

Zip Code

Email Address:

Daytime Phone:

Evening/Weekend Phone:

How did you learn about this program?
(For example, the person you were referred by or the publication where you saw an advertisement.)

What do you hope to gain from taking this program?

I will be paying:

Online by credit card

By mailing a check

At the event **

** advance payment is required in order to reserve a space in any of the programs

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."