Advanced Teacher Training Registration Form (2024/5)

Advanced Teacher Training

Registration Form
Please note: you must have completed all elements of Stage 1 in order to progress to Stage 2 of your training. If you are unsure, you can find information about Stage 1 and 2 of our training here: https://www.breathworks-mindfulness.org.uk/about-breathworks-mindfulness-teacher-training
Booking Information
Have you completed all parts of your Stage 1 training (tick all that apply)?
Choose your course dates
OpenCRM Event
Please select the rate you will be paying
Which Bundle price will you be paying?
Module Combination
How would you like to pay your Stage 2 Bundle?
BUNDLE OpenCRM Event
If an organisation is paying for your course, please provide invoicing details
Stage 2 Bundle means paying for all Stage 2 modules at once and receiving a discount of 10%. If you would like to request a payment plan, please let our training team know by email when they confirm your place.
Participant Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone
Home/Work Phone
Dietary Requirements
Emergency Contact
Please provide contact details for who we should contact in case of an emergency when attending a programme with us.
Emergency Contact Name
Emergency Contact Number

Area CodePhone Number
Updates
If you are registering for TTa, please tell us if there is anything that has happened in your personal or professional life since you attended Stage 1 training that you feel is important to share with us? (For example, change in job, onset of a new health condition, etc.)
Prior to accreditation you need to complete 5 days of meditation retreats. Please check here if you have done this within the last 2 years:
We want to make sure that your Breathworks training is as accessible as possible. If you have any access or communication requirements (eg. related to dyslexia, neurodiversity, physical or mental health conditions, sensory impairment, restricted mobility etc) please give details here:
All meals provided will be vegetarian. Please tell us if you have any dietary restrictions for medical reasons that we need to be aware of.
Math Challenge
Contact Type
CRM retreat req
Should be Empty:

Advanced Teacher Training

Booking Information

Participant Information

Emergency Contact

Updates