Advanced Facilitation Certificate Request Form
The Centre for Mindfulness Studies will issue an Advanced Facilitation Certificate to trainees who have completed all of the required training modules as described at

Certificates cost $90. If you request that your certificate be mailed to you via Canada Post, an additional $5 payment is required.

Payment Options:
• Mail us a cheque made out to "The Centre for Mindfulness Studies"
• Drop by our office with a cash or cheque payment
• Make the payment on Ticketleap at

As a charity, we do not charge HST. However, payments made via TicketLeap are subject to a transaction fee.

Email address *
First Name *
Your answer
Last Name *
Your answer
Your Name (exactly as it should appear on the certificate) *
Please note that CMS will not include professional designations or credentials on facilitation certificates.
Your answer
Are you requesting an Advanced MBCT Facilitation Certificate or an Advanced MBSR Facilitation Certificate *
How would you like to receive your certificate? *
Full Mailing Address
Required if you would like the certificate be mailed to you via Canada Post.
Your answer
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