Registration for Environmental Mindfulness Fall Workshop and Hike- October 22nd, 2017
Welcome and Congratulations for your interest in cultivating greater mindful awareness in your life.
And for your interest in exploring the Cultivation of Presence in the Natural World !

Please know that the information you share here will be treated with confidence and respect.
In addition to some of the basics, it will be helpful to know a bit about your intentions, health and any physical or emotional challenges you may be facing.

Please know that for any question you can make a note that you would prefer to contact us directly with this answer (this will satisfy the reguired response on the form ).

We make a strong effort to have a short phone conversation with all potential participants so anything that feels to personal for an online form like this can be deferred for that phone call.
Looking forward to talking soon. with warm regards, Ken and Maria

Full Name *
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Street Address
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Phone # *
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email address *
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Emergency Contact for Oct 22nd, 2017 *
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What is your primary reason for attending the Environmental Mindfulness Workshop?
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How did you find out about the Programs offered by the NJ Center for Mindful Awareness
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Any other physical health challenges that might be important with regard to your participating in this workshop? *
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Do you have any prior experience with mindfulness practices or have read books about mindfulness?
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Please take note that this workshop takes place in the natural world and includes hiking on wooded trails, which are of course beautiful but also come with possible risks of injury. By registering and clicking "I agree" below you agreeing that you are aware of the risks involved. *
We look forward to talking with you about the upcoming course. Can you please list any preferred days/times when you can be reached by phone. *
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