1.What is your name?

*2.What is your email?(Required.)

3.Do you currently meditate?  (It is completely fine if you are new).

4.How did you hear about the 4-Week Intro to Mindfulness Course?

5.What holidays (if any) do you celebrate?

6.Are there any areas of your life that are particularly stressful right now?

7.What are your tools for managing stress?

Meditation

Yoga

Breath Work

Exercise

Socializing

Therapy

Pets

Helping Others

Television & Entertainment

Food

Shopping

Alcohol

Medical Marijuana (or recreational)

Other (please specify)

None of the above

8.Are you willing to commit to 5 minutes/day of self practice for four weeks?

yes

no

9.This program meets for four Mondays at 7pm in Hancock Park.  I am applying for:

The Full Program: Mondays at 7pm | Nov 14, 28 & Dec 5, 12 ✨ $120

Monday, Nov 14 ~ 7pm ✨ $45

Monday, Nov 28 ~ 7pm ✨ $45

Monday, Dec 5 ~ 7pm ✨ $45

Monday, Dec 12 ~ 7pm ✨ $45

10.Thank you for submitting your request!  We will be in touch asap.

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