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How nice that you want to sign up for this training. If you fill in the form below, we will contact you as soon as possible to confirm your registration.

Overview

For your information, you will find an overview of the data we receive from you below.

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First name*

Last name*

Date of birth*

Emailaddress*

Phone number*

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Number*

ZIP Code*

City*

Country*

Choose your preferred start date here*

Are you a mindfulness or mindful self-compassion teacher? Can you receive continuous education points as a mindfulness teacher in the Netherlands in the ‘Mindfulness Register’?*

Do you have another education/background that makes this course relevant for you?*

Can you say something about your motivation for participation?*

Do you have any questions for the teacher?

I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time without penalty or prejudice, except for the non-refundable course fee. At the present time, however, I am planning to participate in the entire course.

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