Mindfulness Graduate Day Booking Form

Full Name

Telephone Number

Email Address

Full Address (including postcode)

Payment:

Course Cost: £85
Full Payment is required at time of booking to secure your place.
Bank transfer (payable to: Co-operative Bank A/c 12306145 S/c 089103).
Please ensure you put your name in the reference box so your payment can be identified.

If you have any physical illness or other limitation that may make sitting, standing, walking or doing simple exercise difficult, please tell me about it here:

If you have had any mental ill health within the last few years, such as anxiety or depression, please tell me about it here:

If you are taking any medication at present please say what it is and what it is for:

If you are going through any significant life events at the moment please briefly say what they are (eg. moving home, loss of job, relationship issues or divorce, bereavement)

Booking Conditions:

The following proportion of your fee, less a £20 admin charge, will be refundable if you cancel your place on the workshop:

Up to 2 months before the start date: 100%
Less than 4 weeks before the start date no refund will be made.

The facilitator reserves the right to workshop the course under any circumstances. Should this be the case you will receive a full refund.

It is not possible to transfer to another workshop at a later date or to receive a refund if you unable to attend.

Signed:

Date:

If you have any queries about this form or the workshop please contact Gayle Creasey on 07941 279177

Mindfulness Graduate Day Booking Form

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