MSC Intensive Registration Form

Mindful Self Compassion (MSC) Registration form

with Adele Stewart & Tina Gibson
Please make full payment on registration. Registration will

Cancellations received up to or before 1 month before the event – the fee will be refunded less $110.
Cancellations received up to 10 working days before the event – 50% of the fee will be refunded.
Cancellations received 10 working days or less before the event – no refund will be made.
However, if a substitute person can be found so that Adele is not impacted financially there will be a 50% refund.

It is important to intend to be at the intensive for the entire time. This makes a difference to others experience also.
Name*

Preferred First NameLast Name
E-mail*
example@example.com
Mobile Number*
City of residence:
Details you would like Adele and Tina to know to help with your intensive experience:
Dietary requirements (vegetarian)

VeganLactose freeGluten free
Any other questions or comments:

Payment. If using mobile phone, you may need to click over text rather than box. Standard price $1350, Supported $1150, Supporting $1550. Tick box and choose rate. *

MSC Intensive 5 nights single room with ensuite, all meals. Please pay supporting rate if you can afford to support another and supported rate if you need to. Please contact Adele if you wish to share a room: if you have someone to share with or we can find you someone, the cost will be $1250 ($1050 if need supported rate).

$1,350.00AUD Rate

MSC Intensive 5 nights deposit (only if agreed - otherwise pay full amount)Please only choose this box if previously agreed by Adele. Full payment is much preferred.

$110.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Mindful Self Compassion (MSC) Registration form