APPLICATION FORM - MBSR Foundations Residential 2020

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Personal data

First Name *

Last Name *

Date of Birth *

year

month

day

Place of Birth *

Country

Region / State

City

Gender *

Male

Female

Email *

Nickname *

Password *

Street Address *

Country

Region / State

City

Postal / Zip Code

Best Telephone Number *

Other Phone

Education and Profession

Highest Education Degree *

Area of Specialty *

Profession *

Please indicate your prior experience with the following body work
(Yoga - Qi Gong - Tai Chi - Martial Arts)

Mindfulness-Based Stress Reduction (MBSR)

Have you attended the CFM 8 Week MBSR Mindfulness-Based Stress Reduction? *

Yes

No

If yes, when you participated and who was the teacher? *

Have you attended the CFM 8 Week MBSR online course through Sounds True in combination with our Mindfulness Tools: a 5-Day Residential Intensive Program^TM? *

Yes

No

Mindfulness-Based Education and Training

Have you attended MBSR in Mind-Body Medicine: a 7-Day Residential Professional Training^TM? *

Yes

No

Have you attended other MBSR or MBIs Training Programs? *

Yes

No

If yes, can you explain which training you completed? *

If you have been teaching the complete 8-week MBSR course, note the number of courses you have taught and the approximate dates:

Training Background - Additional Pre-requisites

Did you attend any 5-day silent retreats? *

Yes

No

Please indicate the year, duration, location and teacher for one(1) silent, teacher-led meditation retreat you have attended? *

Please describe pathways of inner development that you have intentionally explored in depth (e.g., awareness practices, psychological investigations): *

Curriculum Vitae

Please attach your Resume (.pdf, .doc, .docx, .txt) *

Intention

What calls you to this training? *

I have read and agree to the Privacy Policy *

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Tel. +39 340 4859093 - email: info@motusmundi.it

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