Mindfulness Meditation
Course Registration

Name:
Address:
Address 2:
City:
State/Province:
Zip/Postal Code:
Phone- Work:
Phone- Home:
Phone- Cell:
Email:
Re- Enter Email:
How did you find out about the course?

What brings you to the mindfulness course? In other words, why are you considering a mindfulness practice?

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

Choose the free introduction session that best suits your schedule:
Please select the 8-week meditation course you wish to register for:
	Meditation Course #3 - Start date - Saturday, June 26th, 2010 from 9:30 - noon Meditation Course #4 - Start date - Thursday, September 9th, 2010 from 6:00 - 8:30 p.m.