Registration Form Fall 2022 | imaginemindfulness

Use tab to navigate through the menu items.

What program will you be attending?

Monday 10am PT / 19:00 CET

Thursday 10am PT / 19:00 CET

Saturday 9am PT / 18:00 CET

Please check any that apply to you.

Headaches

Aching joints and/or muscles

Respiratory difficulties

Digestive difficulties

Rapid or skipped heartbeats

Nervousness or anxiety

Lack of concentration or focus

Depressed

Difficulty relaxing

Considering suicide

Feeling desperation or hopelessness

Grieving

Difficulties with anger

Fatigue or weariness

Difficulty sleeping

Current substance abuse

Extreme hearing loss

None of the Above

I have read and understand these risks.

Please sign by checking this box and writing your name below.

Thank you for submitting our Registration Form. We will get in touch with you soon.