Mindfulness + Compassion Professional Training Registration

Registration for the Mindfulness & Compassion Certificate Training

with Sarana Institute
Welcome to the registration page for the Mindfulness & Compassion Certificate Training program. We are so happy that you've chosen to join us. Please feel free to reach out to luke@saranainstitute.org if you have any questions at all relating to applying, we will be more than happy to assist you.

Before submitting registration, please note the module dates available on our website. If you need to postpone attendance to a module, you can make it up in the following Cohort. For Retake and Cancellation Policy read here.

All details including program dates are subject to change and are available on our website.

All Live Sessions take place via Zoom and will be recorded (personal sharing will not be recorded).
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email: *Please use the email address best for your personal correspondence. *

Confirmation Emailexample@example.com
Phone Number*
How did you hear about this professional training?*
Is accreditation important to your participation in the program? (CME, CEU)*

YesNo
Are you an employee with SickKids Hospital?*

YesNo
Are you attending as part of an interdisciplinary team?

YesNo
What is your Professional Role? Please check all that apply.

RNNPLPNLVNSWRPMDOther
In what setting do you work or volunteer? (ex. Hospice, Palliative Care)*
How many years experience do you have?*
Please provide a short description about your interest and intention in enrolling:*
What do you hope to gain from this training personally and professionally?*
Do you currently consider yourself a Meditator or Mindfulness Practioner?*

YesNo
If yes above, please describe your practice, influences and teachers:
Pod Assignments Questionnaire

During the program, you will be placed into a 'practice pod' that will meet on a regular basis between sessions for the purpose of supporting the development of your practice and support in the learning processes of the program. We would like to assign you to a group according to shared professional interests/affinities, such as the type of work you do, setting, nature/length of practice, etc. For example, you may work in a hospital setting, but rather than connect with a hospital-based affinity group, you might choose to join a group that focuses on psychosocial/mental health practice, etc. Please select your 1st, 2nd and 3rd preferences from the list below for a shared affinity for your practice pod. we will do our best to place you with a group that honours your preferences.
First Choice of Pod
Second Choice of Pod
Third Choice of Pod
Anything else you would like us to know?
Registration Fee Regular: $1295
Deposit for Payment Plan: $200

Payment Options:
1. Interac E-transfer to info@saranainstitute.org - Select 'Interac E-Transfer' and then 'Submit Registration' - E-Transfer Password should be: meditation
2. Pay with credit card via PayPal below - Select PayPal and then 'PayPal Checkout'
3. Send a Cheque to our address - Select 'Mail a Cheque' and then 'Submit Registration'

If you are attending on scholarship please select either the e-transfer or send a cheque option below.
Please Indicate Payment Option:
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PayPal Credit Card for M+C Training 2022Select this option to pay via PayPal with a credit card or other PayPal payment method. Then, select the PayPal button below.
$1,295.00CAD



PayPal Credit Card: 6+ Group RateIf you know that you are a part of a corporate group of 6 or more, please pay here or send an e-transfer or cheque with the instructions below.
$995.00CAD



Mail a Cheque - Full Amount or DepositPlease sent a cheque for full amount or $200 deposit to the address provided at the bottom of this form.
$ Free CAD



Interac E-Transfer (Full Amount or Deposit)Please Send E-Transfer after you register to info@saranainstitute.org for your registration to be completed. Password: meditation
$ Free CAD



My employer or group is paying for my course feePlease only use this option if your employer is paying for this course directly.
$ Free CAD



Total

$0.00CAD
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The payment is ready! It will be completed once you submit the form.
SARANA INSTITUTE MAILING ADDRESS
Sarana Institute, 797481 East Back Line
Holland Centre, ON
N0H 1R0
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Registration for the Mindfulness & Compassion Certificate Training

Pod Assignments Questionnaire