Registration Breathworks Certification English 2022

title

first name *

last name *

M    F    other

company name

address *

zip code *

city *

country *

phone number (without space bar) *

email *

year of birth (YYYY) *

What is your profession?

Mindfulness teacher training: please describe the teacher training program(s) you have completed. *

Please describe your experience with teaching mindfulness, or applying mindfulness practices in your work: *
yes no

Have you completed an MBSR/MBCT teacher training? If yes, where?

If you have completed an MBSR or MBCT training: At which training institute did you complete the training?

If you have completed an MBSR or MBCT training: in which year did you complete the training?

If you are an MBSR or MBCT teacher: How many 8 week courses have you been teaching since now? MBSR-courses: _____  MBCT-courses: _____ other formats: ____

What are your professional experiences with people who suffer from chronic pain?

In what context would you like to offer MBPM courses (as far as you already know)?

Please describe your expectations for the seminar/ training (private and perharps professional).

Food needs: dairy-free, nut-free, glutenfree

Is there any other information you would like to share with the teacher(s)?

Additional comments

Payment *

After registering, you will receive an automatic registration confirmation with the request to transfer a registration fee of 100€.

Your place in the seminar is only reserved after receipt of the registration fee. Registrations will be considered after receipt of payment.

About 8 weeks before the seminar begins, you will receive a detailed letter with further information on the seminar and an invoice for the remaining seminar fee. We ask you to transfer the seminar fee to the specified account no later than 14 days before the seminar begins.

With kind regards,

Marie Danberg

 

 

€ 1.420,00 (Seminargebühr)

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The personal data is stored for the purpose of electronic data processing and is subject to data protection. All persons who have access to the data undertake not to pass these on to third parties. The storage of data is only for the purpose of registration and the personal information of the user and possibly his legal representative.
* I have read the privacy policy and agree that contractor and user data are stored electronically. .

General Terms & Conditions
Our general terms and conditions apply to this agreement.
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* I agree with the aforementioned conditions and register for Breathworks Certification English 2022 from 24-11-2022 until 18-12-2022.