Registration Five-Day Silent-Retreat with Vidyamala Burch & Sona Fricker 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?

Do you have experience with Yoga or other forms of body centered approaches (tradition, practice, duration, frequency, number of years)? *

What is your experience with Meditation (tradition, practice, frequency, duration, number of years)? *

Retreats: please describe your retreat experience (tradition, teachers, duration, number of retreats/years). *

Other personal information: Do you currently experience major health issues? If yes, please describe. Do you suffer from serious psychological problems, such as addictions, anxiety, depression? Are you currently in therapy? Do you take any medicine for your mental health? Please describe here. * * Please note: answering "yes" to this question does not automatically mean you cannot participate. Since psychological issues / complaints can influence your meditation practice and vice versa we like to get in touch with you personally before the start.

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: ____

Please describe what meditation means for you and how you pratice it in everyday life and how it helps you. 

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

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

Who may we reach in case of emergency? Please list phone number, name and relationship. *

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

 

€ 620,00 (Seminargebühr)

PRIVACY POLICY
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.
* I have read and agree to the terms and conditions.

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* I agree with the aforementioned conditions and register for Five-Day Silent-Retreat with Vidyamala Burch & Sona Fricker 2022 from 08-05-2022 until 13-05-2022.