Retreatant Registration Form

Mindfulness Course Enquiry Form

FREE Mindfulness courses in Salford, Trafford and Online. This is an ENQUIRY form it does not guarantee a place on the course. The trainer will be in touch after they have received your form to discuss the course with you. Everything contained in this form is kept CONFIDENTIAL and will be seen only by the course trainer.
Full Name*

First NameLast Name
Phone Number*

Phone Number
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about the course?*
In-person in Eccles, SalfordIn-person in Urmston, TraffordOnline (Salford resident)Online (Trafford resident)
What do you hope to get out of the course eg; finding ways to manage stress or a long-term health condition, feeling better able to cope with life's ups and downs, meeting like-minded people*
Please share any mental or physical health conditions, or symptoms relating to a previous traumatic event - we want to tailor the course to your needs, so if you can share as much as possible that would be helpful:*
YesNo
If yes, please share some details:

Mindfulness Course Enquiry Form