Registration Form
This form is to indicate your interest in the Mindful Self-Compassion 8-week program. Please answer all questions to the best of your ability. Once we have received registration we will be in touch to finalize your application process and arrange for payment. None of the answers on this form will have any impact on your inclusion in the program.
Please let us know where you heard about the program. *
Your answer
Please indicate your payment category. *
Please indicate your payment option preference: *
If you marked the "Previous Attendee" please state type of program and year attended.
Your answer
Name: *
Your answer
Phone number and best times to call: *
Your answer
Best e-mail for contact: *
Your answer
Why are you interested in attending this program at this time?
Your answer
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