Sign up for Mindful Selfcompassion Intensive

Nice to see you sign up for a refresher course. If you fill in the form below we will contact you as soon as possible to confirm your sign up.

Overview

You can see an overview of the information we will receive from you.

"*" indicates required fields

1Step 1

2Step 2

Personal info

First name*

Last name*

Age*

Job*

Address*

Street Address City ZIP / Postal Code Country

Phone number*

Extra phone number (optional)

Email address*

For which training do you want to sign up?*

Information for the trainer

How would you describe your bodily health in general? Example is excellent, quite good, average, weak.*

Have you ever been to therapy? (If so, would you like to state something about the reason, length and whether the therapy or causes for this are still current?)*

Are you currently taking any psychoactive medication, or any other medication that could affect how you feel from week to week? (If yes, please explain.)*

Is there anything else that is good for us as trainers to know?

If you have previous experience with meditation, mindfulness, or compassion training, can you briefly describe it?*

Do you work professionally with mindfulness and/or compassion? If so, can you briefly describe it?*

Additional questions

Do you want to receive the newsletter?*

Yes

Number

reCAPTCHA

This field is for validation purposes and should be left unchanged.

Sign up for Mindful Selfcompassion Intensive

Sign up for Mindful Selfcompassion Intensive

Personal info

Information for the trainer

Additional questions

Schrijf je in voor de nieuwsbrief

Contact