Registration page – A Day of Mindfulness

First Name *

Last Name *

Licensure (CW, LP, other):

Organization/Agency:

Email *

Preferred Phone *

Address *

City *

State *

Zip *

How do you use mindfulness in your professional life (or how you hope to):

What would you like to get out of this experience?

Have you attended the 8-week MBSR series, and if so, when and where?:

If you have attended a True Nature Mindfulness offering in the past, would you be willing to leave a testimonial?

Yes

Testimonial

May we publish your testimonial on our website and other social media?

Yes

How would you like to be recognized?

Program fee

$150, which includes the program and your Continuing Education Certificate

Payment method *

Check

Credit Card via PayPal

PLEASE NOTE: Your registration is not complete until your payment is received. Checks delivered by mail may take several days.

THANK YOU SO MUCH FOR YOUR PARTICIPATION!

I LOOK FORWARD TO BEING WITH YOU. Paula

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