• Mindfulness for Health Course: Registration Form

  • Before you start filling this form, please check the bottom of the page for 'Submit' button. If it is not there, please click this link to reload the page.

  • Tell us some basic information

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  • Date of Birth*
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  • Next of kin

  • Please provide contact details for who we should contact in case of an emergency when attending a programme with us.

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  • Tell us about you

  • Is training to become a mindfulness teacher or facilitator on your horizon?*

  • Please note: if you're planning to train as a teacher with Breathworks, it's important to approach the 8-week course fully as a participant, rather than as part of your teacher training journey. This helps ensure that every teacher deeply embodies the practice. The intention is to focus on your own personal development throughout the course.


     

     

  • Additional information

  • Is someone else paying for your course (not including employer) or have you used your different name from this form while paying for the course?*
  • Are you paying (or a person that paid for you) for more than one person?*

  • If there is more than one person on the receipt, please share the link to a blank registration form provided below to everyone included in the payment.

    Mindfulness for Health registration form

  • Payment information

  • Please select whether you would prefer to pay the full amount, or if you would prefer to split the payment over 4 installments.  

    If you select to pay in installments, when you submit this form, you will be re-directed to the Breathworks website to set-up a paypal subscription.  From this page click 'Subscribe' and follow the onscreen instructions.

  • Payment Method *
  • Which of these have you done with Breathworks so far? (tick any that apply)
  • Is your organisation paying for the course?

  • If your organisation is paying for you to attend the course, please forwad the link below to the person who is responsible for rising the Purchase Order. 

     

    Organisation Invoicing Details form

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  • If you can remember, how did you first hear about Breathworks?*

  • Keeping in touch

  • Communication Preferences

    Newsletter sign up

    Tick the box below to receive our email newsletters relating to Breathworks and Mindfulness that we think you may be interested in.

  • • This contact will always come from The Breathworks Foundation
    • You will receive approx 1-2 emails per week.
    • We will never sell or pass your details to other organisations without your consent.

  • Privacy & Cookies Policy

  • Download Privacy and Cookies Policy 

  • Cancellation Policy

  • Cancellation Policy

    1. The following proportion of your fee will be refundable if you cancel your place on the event:
      • Up to 7 days before the event starts you will receive a refund of any course fees paid, less a £35 admin fee.
      • If cancelled within 7 days of the start date we cannot refund any of the fees paid.
    2. Up to 7 days before the event starts, you can transfer your booking (and all fees paid) to another comparable event.

     

     

  • Thank you for taking the time to complete this form. Please take some time to familiarise yourself with the cancellation policy.

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