The Canberra Mindfulness Centre

Information

Please complete and send the form below

Event Registration

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Registrant

Title

Last Name *

First Name

Occupation

Email *

Phone (h) *

Phone (w)

Phone (m)

Address *

Suburb *

City *

State *

Country

Post Code *

Course Details

Preferred Course

Term

Preferred Session

Payment Method

Payment Method Description

Please make cheques payable to Sue Hays

PLEASE BE SURE to record your surname in the reference field
Account name: Sue Hays
BSB: 012 950
Account Number: 900 364 336

Please bring your card to your pre-course interview

Would you like a Payment Plan No Thanks Yes Please

Message

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Terms

In applying to register for the Canberra MBSR course, I hereby absolve and indemnify the Canberra Mindfulness Centre and all their servants, agents, employees from all liability arising from injury or damage in connection with my participation in programmes provided by or in connection with the Canberra Mindfulness Centre.

I agree to Terms