Finding Inner Peace Registration

Your Name (required)

Your Email (required)

Address

Reason for taking this course

Have you ever taken a Mindfulness Meditation class before?
 Yes No

If YES, when and with whom

What is your meditation experience level?
 Never meditated before Tried meditation a few times Meditate irregularly Meditate regularly

How did you hear about the course?
 From a Friend From a Flyer From the Teacher Online Other

What is your current stress level?
 Low Moderate High-but I enjoy the challenge High-sometimes difficult to handle

Are there any medical conditions or disability that may be of concern while taking this course?

Are there any mental health conditions that may be of concern while taking this course?

Do you have a question or message about the course?

To assure your spot, please write your check to: Andrea Colombu LMFT and deliver or mail to: 23a Orinda Way, Orinda CA 94563