Anxiety, Stress & Mindfulness Registration Form
Registration Form
Date *
MM
/
DD
/
YYYY
Name *
Your answer
Age *
Your answer
Town/City *
Your answer
I live in Newfoundland and Labrador *
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)? *
If "No", how many sessions can you commit to attending?
If you are unable to attend a session, will you let Andrew Safer know in advance (by email, text, or phone)? *
Which of the following do you have to connect to the weekly sessions? *
Required
How did you find out about Anxiety, Stress & Mindfulness? *
Your answer
Fee: None
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