Living Mindfulness Application Form
This is an application form for the Living Mindfulness programme. The information you provide is collected for the purpose of facilitating this programme. Once the programme is complete your information will be deleted excluding your name and contact details. See Privacy Policy on the website at http://mindfulway.ie/privacy-policy/
Name *
Address *
Phone number *
Email address *
Date of Birth *
Occupation *
Reasons for attending and your expectations *
Any previous experience with meditation /mindfulness? If yes, please give details *
Any physical, mental or emotional difficulties that you would like us to be aware of? If yes, please give details *
Do you have any difficulties that makes sitting, standing, walking or doing simple yoga movements challenging for you? If yes, please give details. *
Current state of health and wellbeing *
Are you presently on any medication we need to be aware of? If yes, please give details *
How did you hear about this Living Mindfulness course? *
Any other information you think would be important for me to know?
Can we add you to the Mindful Way mailing list? *
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