Mindfulness Couples Retreat Registration

This form is mandatory to register for the Couples Retreat happening (dates to be announced soon).
Course fee is Rs.8000/- per couple.
After registering please Whatsapp us on 9011036828.
Email address *
Bank Details
Account Name : Just Being Center For Mindfulness And Presence LLP
A/c Number : 007305011303
IFSC : ICIC0000073
Account Type : Current
Bank : ICICI Bank, Pune - Aundh
Branch : Pune Aundh (000073)

Cheque to be Addressed to: Just Being Center For Mindfulness And Presence LLP
Full Name *
Partner / Spouse's Full Name *
Ages *
Enter both participants ages separated by a comma
Mobile number *
Full Address *
Where did you hear about us? *
We are interested in this Retreat because... *
I have read course details and requirements, payment details. I understand that my seat will be confirmed once I make the payment of Rs 8000/- to Just Being. *
Required
Mode of Payment. *
Just Being seeks to make programs and trainings available to all. We maintain a scholarship fund to enable those with financial constraints to attend quality trainings that will benefit others. If you would like to contribute to the scholarship fund to enable others to attend as well, it is very welcome. You can make any additional contribution in addition to your fees towards the fund. *
Amount for Scholarship
Transaction reference no. / Check no. (if applicable)
Any other details / preferences or comments
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