MBSR WAIT LIST

Please complete this form to register your interest for any upcoming programs

You will be contacted by phone for a chat about the program to make sure you think it is a good fit for you! :-)

Name

First NameLast Name

Student ID Number (begins with a 2)

Mobile Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Flinders student email address

example@flinders.edu.au

Which degree/masters/PhD are you studying

How did you hear about this program?

Are there any anticipated challenges or issues for you with regards to your participation in the program that the teacher need be aware of?

The course consists of 8 x 2.5 hour weekly sessions and homework tasks which consist of weekly readings and home practice mediations. Is there anything that will get in the way of you participating fully?

Please read our Privacy Collection Statement

1. I have read and understood the Privacy Collection Statement linked above; and 2. I consent to Flinders University collecting, using and disclosing my personal information (including sensitive information) as described above and otherwise in accordance with our Privacy Policy.