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Your booking is NOT complete until we have reviewed your application form.HiddenUser First Name First Name* Last Name* Address* Address Address 2 Town County ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*HiddenMobileHiddenWork PhoneEmail* HiddenWebsite Sector* Education Health & Social Care Criminal Justice Finance Hospitality & Leisure Retail Technology Organisation (if funded through employer) Occupation or role related to your application* Mindfulness Teacher Training*Education/CertificateDate CompletedOrganisation Formal Relevant Education, Qualifications and Trainings: Evidence of completion*Accepted file types: jpg, png, pdf, docx, doc, Max. file size: 125 MB.Please upload a certificate or confirmation from your training providerRelevant Work History*Education/CertificateCompletedLength of Training Formal Relevant Education, Qualifications and Trainings: We promote equality, inclusion and diversity so have flexible payment plans. Do you need to talk to us about ways to make the training more accessible to you?* Yes No If "yes" please give details below and indicate how we might be able to support your learningDetailsWhere did you find out about this course and how do you intend to use your accreditation once you have completed the course?* Tell us about your current mindfulness meditation practice, including both formal and informal practices* Do you have any logistical, health or practical requirements that may need support by MindfulnessUK? Please let us know these details on application via info@mindfulnessuk.com* Yes No (We find it helpful to know some details of your relevant health history so we can ensure safety for you and others, and to support your learning. Please let us know if there is anything we need to be made aware of to either by completing the section below or contacting us at MindfulnessUK.) Declaration I have read and understand the Cancellation Terms and Conditions here. I understand that I am committing to the entire MindfulnessUK training programme, its tuition fees and the fee payable to the awarding body (where applicable) and that I am over 19 years old. I declare that all information contained within this application form is accurate. I have read and accept all the terms above* I accept Do you consent to your image or feedback being used in our publicity materials?*Photos, videos, and feedback or testimonials are a good way for us to increase awareness of mindfulness and compassion and they are often taken or captured during teaching sessions and related events. We use this content gathered in publicity materials including printed and online publications, promotional videos, website and social media, PR, promotional materials and advertising. Please choose whether or not you consent to your image or feedback being used. Yes No Declaration I have read and understand the Cancellation Terms and Conditions. I understand that I am committing to the entire MindfulnessUK training programme, its tuition fees and the fee payable to the awarding body (where applicable) and that I am over 18 years old. I understand that I am required to be an ongoing member of the MindfulnessUK Alumni in order to deliver the CMR course at any time in the future and will be required to complete and sign an agreement with MUK about usage of materials before you will be given access to the teaching materials.Print Name Date Δ