Application Form

Educational and Supervisory Frameworks Informing Mindfulness-based Supervision – 10/10/2019


Terms & Conditions

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I confirm by ticking this box that I have read the course description and relevant information sheets and understand and agree to the payment and cancellation arrangements of the Mindfulness Network.
About you
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Where did you find out about this course?

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Your physical health
Do you have any physical illness or other limitation that may make hearing, sitting, standing, walking or doing simple exercises difficult for you?

Please provide further information about your physical illness/limitation:
If you have significant physical health problems, please tell your GP that you are undertaking the course.

Your mental health
Have you had any mental health issues or concerns within the last few years, such as anxiety or depression?

Please provide further information regarding mental health issues or concerns:

Are you taking any medications or over-the-counter drugs at the moment?

Please list your medications here:

Course fees
You can choose to pay the entire amount for this event or just the deposit. However, if your application is within 4 months, then you will be invoiced for the full amount. If you have paid a deposit, 4 months before the start date you will be invoiced for the balance which must be paid within 30 days. If the total cost of the event is less than £500 the deposit will not be listed as an option.

Please select the fee that you’re paying.

Is your fee to be paid by your employer?

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Do you have a purchase order number – if you are working within the NHS, this is usually necessary:

Other

Any other information you would like to pass onto the admin team or teachers in connection with this application: