Register for Taming Your Inner Critic
Developing Self-Compassion

ONE TIME PAYMENT REGISTRATION

March 24-May 12, 2020
8 Tuesday Evenings from 7pm - 8:30pm

Cost: $400 or $55/class (10% Discount if paid in full)

If you wish to pay per class please click HERE otherwise complete the form below.

Please note: This information will only be read by the course instructors. If you feel uncomfortable answering any questions, please note that on the form and we can have a private conversation before the program begins or simply leave it blank. Leaving a question blank will have no impact on inclusion in the program. Thank you.

Name*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Occupation*
Home Phone*
Enter your cell phone if you do not have a home phone
Cell Phone
Work Phone
Date of Birth
Date Format: MM slash DD slash YYYY
How do you self-identify your gender?*
Education
Why are you interested in participating in this program?
Please be advised that Taming Your Inner Critic is designed for personal growth and development.
Do you have a regular practice of meditation? If so, what type and how many years have you been practicing?
Please note that it is not necessary to have any experience of meditation prior to this program.
How would you describe your physical health?
Are you currently in psychotherapy?
Please consider providing the name and number of your therapist if you think that might be helpful.
Are you currently taking psychotropic medication, or any medication that may affect how you feel from one week to the next?
If so, please provide details.
If there anything else that might be helpful for the instrutors to know at this time?
I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time without penalty or prejudice, except for the non-refundable course fee. At the present time, however, I am planning to participate in the entire course (including the retreat), and to practice mindful self-compassion up to 30 min/day (formally or informally).*
- I Agree
Taming Your Inner Critic Class*
Price: $400.00

Register for Taming Your Inner CriticDeveloping Self-Compassion

ONE TIME PAYMENT REGISTRATION

Register for Taming Your Inner Critic
Developing Self-Compassion