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 *
Your answer
Address *
Your answer
Phone number *
Your answer
Email address *
Your answer
Date of Birth *
Your answer
Occupation *
Your answer
Reasons for attending and your expectations *
Your answer
Any previous experience with meditation /mindfulness? If yes, please give details *
Your answer
Any physical, mental or emotional difficulties that you would like us to be aware of? If yes, please give details *
Your answer
Do you have any difficulties that makes sitting, standing, walking or doing simple yoga movements challenging for you? If yes, please give details. *
Your answer
Current state of health and wellbeing *
Your answer
Are you presently on any medication we need to be aware of? If yes, please give details *
Your answer
How did you hear about this Living Mindfulness course? *
Your answer
Any other information you think would be important for me to know?
Your answer
Can we add you to the Mindful Way mailing list? *
Your answer
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