Mindful Living

Mental Health Professional's

Class Registration

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Phone- Work:
Phone- Home:
Phone- Cell:
Licensure:
Email:
Re- Enter Email:
How did you find out about the class?

Please, tell us a little about your counseling practice & the type of people you work with:

Please provide a brief description of your experience with mindfulness meditation.

Please write what you hope to get out of the class:

Please confirm that the dates & time below are what you intend to register for, and then click on submit:
	8 - Week Mindfulness Course for Mental Health Professionals beginning Friday, January 22nd 2010, from 1:00 - 3:30 p.m.

Upon completion and submission of the class registration form, we will send you a registration confirmation. If you do not receive the notification, please call 713.522.7032 or email us.

To RESERVE A SPOT in the course you may:

Make a $200 NON-REFUNDABLE deposit

Pay the entire class fee of $550, part of which includes the deposit.

To make either type of payment, please click here.