Course booking form

Course Booking Form Spring 2018

To register your place please complete this course booking form. Pippa will then be in touch via email to confirm your place and payment details.

Section 1: Personal details
Your name*
Telephone*
Email*
Address*
Section 2: Course details
Spring 2018 Courses*
- Tuesday evenings Portishead
Section 3: Payment
Please select how you wish to pay:*
- Online transfer
- Cash
- Cheque
Pippa will contact you with further payment details on receipt of this form.
Section 4: Further information
How did you find out about this course?
Other – please specify:
What are your reasons for doing the course?
Do you have any previous experience of meditation or mindfulness?
Do you have any physical, medical or mental health conditions that the course leader should be aware of?*

*Courses are not suitable for those with psychiatric illness or serious mental health conditions, e.g. paranoia or schizophrenia. Ultimately, students are responsible for their own health.
Section 5: Cancellation policy
If you cancel more than 14 days prior to the start of the course, you will be refunded your full deposit and any course fees paid up to this point. Less than 14 days prior to the start of the course, your deposit and course fee will be non-refundable and you will be offered the option to re-book a place on the course for alternative dates.
Section 6: Declaration
- I confirm that I fully understand the questions and statements in this form.
- I confirm that all the information I have given is correct and complete.
- I understand that a £50 deposit is payable to secure my place on the course.
- I agree to pay the full balance of my course fee by 14 days prior to the course start date.
- I have read and I understand the cancellation policy and note that I must provide 14 days notice prior to the start date of the course if I wish to cancel my place and receive back my deposit.
- I understand this course provides guidance for personal development and is not a substitute for any form of therapy. Ultimately I am responsible for my own health.
- I understand my personal details will not be passed on to any third parties unless required by law.
I agree to the booking terms*
- Yes, I agree

Pippa Craggs

Course Booking Form Spring 2018

Section 1: Personal details

Section 2: Course details

Section 3: Payment

Section 4: Further information

Section 5: Cancellation policy

Section 6: Declaration

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