registrationform

First Name
Last Name
Street

City
State
Zip
Email
Phone
Payment Method
Proposed Alternate Payment Plan
Agree with the deposit and cancellation/refund policy
Agree with the dual relation policy
Please describe your past experience and interest in mindfulness and psychosynthesis and how participating in the training fits with your personal/professional aspirations. If you see taking the training as a next step in a developmental process that is unfolding, try to describe this process in some detail. Offer any additional information relevant for understanding your interest in the program.
Please bring to our attention any conditions you may have that may affect your participation in the training program such as past or current health status, psychiatric conditions, major stressors.
Questions? Comments? Request phone consultation? Request group discount? Request scholarship?

Tuition Payments are invoiced through Paypal unless other arrangements have been made.

last update: 5/15/16