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Anxiety, Stress & Mindfulness Registration Form
Registration Form
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Date
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MM
/
DD
/
YYYY
Name
*
Your answer
Age
*
Your answer
Town/City
*
Your answer
Phone (Cell if available)
*
Your answer
Email Address
*
Your answer
If, after the first session, you would like to continue with Anxiety, Stress & Mindfulness, can you commit to attending the whole series (12 sessions)?
*
Yes
No
If "No", how many sessions can you commit to attending?
6
8
10
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If you are unable to attend a session, will you let Andrew Safer know in advance (by email, text, or phone)?
*
Yes
No
Which of the following do you have to connect to the weekly sessions?
*
Computer
Tablet
Smartphone
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How did you find out about Anxiety, Stress & Mindfulness?
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Your answer
Fee: None
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