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Course information.

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Course*
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Retreat Day dates*

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Retreat Day Saturday 3rd October 2020

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Retreat Day Saturday 5th December 2020*

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MSC: Inner Resilience - 20th of October, 10am - 4pm*

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Creating Balance - 3rd of November, 10am till 4pm*

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Registration Data

First Name*
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Last Name*
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Age (Optional)

Contact Number*
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Preferred contact time
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Your Email*
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Postcode

Do you have any special conditions to be catered for (e.g. dietary, accessibility, etc.)?

Payment Details

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Preferred payment option *
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If you are applying for a concession rate, please share a little about your current circumstances

Further Information only for MSC Programs

If you are registering for a retreat day or workshop, this information is not required.
What interests you about the program and what are you hoping to gain?

Can you make the commitment to attend all sessions?
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Can you make the commitment to practice the mindfulness and compassion skills in between each session?
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Compassionate Choices

I agree to print and complete the following Compassionate Choices form
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Click here to download the form.

Emergency contact name and mobile number.

Please share details of any previous meditation experience

Please note any current mental health problems or significant life issues you are experiencing

If so, are you under the care of a mental health practitioner?
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Additional Information

Are you happy to subscribe to our quarterly newsletter?
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How did you hear about Adelaide Mindfulness?

Please include any comments or questions you may have

Privacy Policy & Terms and Conditions

We value our community and ensure the data we collect is handled sensitively, securely, and with due regard for personal privacy. We will not release your email address or personal information to any other party.

Submission of this registration form is not confirmation of your position in the program/ workshop. We will be in touch with you shortly to confirm your place and discuss payment details.

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Compassion-Based Mindfulness Programs and Workshops:
Creating and delivering individual sessions or group training in Mindfulness, Meditation, Compassion and 
Self-Compassion to manage problematic stress and anxiety.
© 2020, Adelaide Mindfulness