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How nice that you want to sign up for this training. If you fill in the form below, we will contact you as soon as possible to confirm your registration.

Overview

For your information, you will find an overview of the data we receive from you below.

"*" indicates required fields

First name*

Last name*

Date of birth*

Emailaddress*

Phone number*

Street*

Number*

ZIP Code*

City*

Country*

Choose your preferred start date here*

Why are you interested in participating in this program? (Please be advised that MSC is designed for personal growth and development.)*

How would you describe your physical health (i.e excellent, good, fair, poor)*

Have you ever been in (psycho-)therapy? (If so, please provide some more information on why, since when and if therapy or the reasons for therapy extend to the present.)*

Are you currently taking psychoactive medication, or any medication that may affect how you feel from one week to the next? (If so, please provide details.)*

Is there anything else that would be helpful for the instructors to know at this time?

Please describe prior experience with meditation, mindfulness and/or compassion training (if any).*

Do you work as a professional with mindfulness and/or compassion? If yes, could you give a short description?*

I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time without penalty or prejudice, except for the non-refundable course fee. At the present time, however, I am planning to participate in the entire course.

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