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Introduction to Mindfulness (MBSR) Course Registration Form

_{Payment plans available (see below).}_{Limited need-based support & mail-in registration forms also available by contacting the Center.}

Contact Information

Name *

First Name

Last Name

Email *

Verify Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Do you need the course text, "Full Catastrophe Living" by Jon Kabat-Zinn? *

Yes, please provide me with the text.

No, I have (or will obtain) my own copy of the text.

Please be sure you have (or obtain) the 2013 revised edition.

Payment Options *

$350 - Full Course Fee (includes book)

$335 - Full Course Fee (no book)

$175 - Payment Plan (2 payments, one month apart)

$87.50 - Payment Plan (4 payments, spread over 4 months)

Payment Plan Schedule

If other, please specify

Is there someone we can thank for referring you?

Add 3% to my total amount to help cover the payment processing fees