Registration Breathworks Introduction 2021

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?

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: in which year did you complete the training?

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).

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

How did you hear about this program? *

Additional comments

Payment *

After registering, you will receive an automatic registration confirmation with the request to transfer a registration fee of 50€. 

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

€ 550,00 (seminar fee)

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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 Introduction 2021 from 12-03-2021 until 14-03-2021.