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.
* Required
Email address
*
Your email
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
*
Your answer
Partner / Spouse's Full Name
*
Your answer
Ages
*
Enter both participants ages separated by a comma
Your answer
Mobile number
*
Your answer
Full Address
*
Your answer
Where did you hear about us?
*
Facebook group
Instagram
Whatsapp
Email
Referred by someone
Previous participation in Just Being courses
Other:
We are interested in this Retreat because...
*
Your answer
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.
*
Yes
Required
Mode of Payment.
*
Cash
Cheque
Online
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.
*
Yes
No
Amount for Scholarship
Your answer
Transaction reference no. / Check no. (if applicable)
Your answer
Any other details / preferences or comments
Your answer
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