First and Last Name *

Age *

Instrument *

Phone number *

Address *

How did you hear about this program? *

Where and with whom have you studied your instrument? *

How long have you been playing/singing? *

What experience, if any, do you have as a performer? As a teacher? *

What is your goal or ambition as a performer? As a teacher? *

What experience, if any, have you had with mindfulness? *

Why are you interested in mindfulness? *

Why do you wish to take this program and what do you hope to accomplish? *