Mindfulness Based Programs Sign Up Form
Please let us know which program(s) you're interested in and your availability:
Email *
First and Last Name *
Today's Date *
MM
/
DD
/
YYYY
Which Mindfulness Based Program(s) are you interested in? *
Required
Please indicate your availability (select all that might work for you): *
10 am - noon
1 pm - 5 pm
5 pm - 9 pm
Not Available
Other*
Saturdays
Sundays
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
*If you selected "other" in the above chart, please describe here:
Anything else you would like us to know?
Thank you - we will contact you when we have sufficient interest in a given program.
If you have any questions, please email us at info@mindfulness-alliance.org
A copy of your responses will be emailed to the address you provided.
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