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.
Please indicate your payment category.
Full payment by March 11, 2020 for early bird discount. ($550)
Full price. ($595)
Previous attendee (let us know type of program and year attended below). ($350)
I am not able to pay this amount and would like to apply for a scholarship for part of the cost. (Limited availability.)
Please indicate your payment option preference:
Full payment as a lump sum.
Payment plan/installments to be completed by start of course unless otherwise discussed.
If you marked the "Previous Attendee" please state type of program and year attended.
Phone number and best times to call:
Best e-mail for contact:
Why are you interested in attending this program at this time?
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