Mindfulness Course Bursary Request

Mindfulness Course Bursary Request
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Which course are you interested in?

Mindfulness for Stress OnlineMindfulness for Health OnlineMindfulness for Stress In PersonMindfulness for Health In Person
How much would I be able to contribute to the cost of the course?
Feel free to provide us with any information you might feel is helpful for us to know about (optional).
Breathworks CiC and The Breathworks Foundation would like to contact participants of bursaries about their experience on a Breathworks Course for research and marketing e.g testimonials. WLBC will only share email addresses of those who have given us permission to. This is optional.

Yes, I agree for WLBC to share my email address with Breathworks CiC and The Breathworks Foundation.
How did you hear about us?

WLBC Weekly NewsletterWLBC WebsiteSocial Media (Facebook or Instagram)Word of MouthBreathworksWalking past the West London Buddhist CentreI have previously attended an event at the West London Buddhist Centre
If other, please state:
Should be Empty: