Application Form: Mindfulness Module

Name: / Male/Female / DOB
Address: / Phone/Mobile:
Email:
CIMSPA Number:
Style(s) of yoga or movement practiced:
How long have you practiced? / For movement teachers only:
How long have you taught?
Number of classes per week?
Please list qualifications & with whom you trained and other qualifications that you feel are relevant:
Do you have any physical limitations that may affect your ability to take movement practice?
Have you had or do you have any mental health issues that you feel we need to be aware of in terms of taking introspective practices?
Are you currently taking any medication?
Kindly provide details of your experience of breath work and/or meditation.
What is your experience of Mindfulness?
Please outline any other Mindfulness courses, training or retreats you have already undertaken
Please indicate what has drawn you to this course
Thank you for taking the time to complete this application form. All information will be treated in the strictest of confidence. Kindly return the completed application to

Payment and Cancellation Information

Electronic payment to:

  1. Sort Code: 601609; Account Number: 71657606
  2. Please use your name as a reference.

Members fee: £625.50 + £60 (BWY Reg Fee)

Non-members fee: £695 + £60 (BWY Reg fee)

Next Placements:

▪Non-returnable deposit of £100, due upon acceptance of an offer.

▪AND

▪BWY Registration Fee: £60, due1st February 2018.

Following this step, there are 2 options:

  1. Balance of payment due by1st February 2018.
  2. OR, Instalment option for balance of payment: Members: 3 instalments of £190, non-members: 3 installments of £215 due 1 February, 1 March, 1 April 2018, with a signed contract to this effect.

Any course fees paid after 5th February 2018: Members: £675, non-members £745 (+£60 BWY Reg Fee).

Cancellation Policy

Within two weeks of the course, no refund will be offered for cancellations. Prior to this, 50% of the course fee (minus deposit) will be refunded.

If sufficient notice is provided, and at our discretion, every effort will be made to transfer your application to another course, minus the admin fees.

………………

Places on this course are limited. Please apply early to avoid disappointment.
Those wait listed will be informed as soon as places become available.

Kindly tick to acknowledge that you understand and accept the payment and cancellation policy and that you wish to apply for the above module

We shall communicate with you by email and provide an electronic receipt.

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