Mindfulness-Based Stress Reduction (MBSR)

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This is the registration form for the MBSR course on-line / in person in Prague.
The course is lead by Jaroslav Chýle, Qualified MBSR Teacher (Center for Mindfulness, University of Massachusetts Medical School), and it is a professional clinical mindfulness training program.
The course involves up to 30 hours in group, including the whole day session on a Saturday, recordings, manual and lifetime opportunity to take part in the whole day sessions if the course is successfully completed. Certificate of attendance is available.
The price: CZK 7900/EUR 310/USD 370 on-line OR CZK 8900/EUR 350/USD 410 in person. Individual discounts for people in need are available.
More info at http://www.mbsr.cz/p/english.html
Please give your phone number if you have not been to the orientation session yet.

Surname *

First Name *

Email *

Phone (Czech number)

I register for the MBSR orientation session on-line on (the time zone is CET Prague):

Wednesday 10 February 2021, 12-1 pm

Thursday 11 February 2021, 6-7 pm

Wednesday 17 February 2021, 5-6 pm

Friday 19 February 2021, 6-7 pm

Other:

Clear selection

I will not participate at the orientation session, because

I have already participated

I am not able to participate, but I am seriously interested in taking the MBSR course

Other:

Clear selection

I intend to participate at the eight-week MBSR course (please tick your all options): *

on-line (Thursday 6-8 pm)

on-line (Monday 10-12 am)

Prague (in person)

Other:

Required

I have learned about MBSR *

from a former participant

from a physician

from a psychologist/psychotherapist

in college

in another training / education

on Facebook

on the internet

in a book

in printed media

Other:

Required

Your questions / comments:

Data protection rules *

I am providing any and all personal data filled in this form, including my surname, name, email address and phone number ("personal data") voluntarily. My personal data shall be processed only to the extent necessary for the registration and record of potential participants of the MBSR program lead by the data administrator, Jaroslav Chýle, IČ: 492 285 10 (the Administrator) for the purposes of fulfilment of a service contract. My personal data shall be stored by the Administrator in a protected electronic database and they will NOT be accessible to a third party. As a data subject, I have the right to access my personal data and shall I find out or believe that the Administrator carries out the processing of my personal data contrary to the protection of my private and personal life or in violation of the law, my personal data are inaccurate with regard to the purpose of their processing, I have the right to ask the Administrator for explanation, the right to request blocking, correction, amending or liquidation of my personal data.

I hereby acknowledge and accept the above data protection rules.

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