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MASTERMIND MINDFULNESS CERTIFICATION APPLICATION
Name
*
First
Last
Email
*
Birthday
*
Date Format: MM slash DD slash YYYY
Preferred Gender Pronoun
he/him
she/her
they/them
Phone
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Home Mailing Address
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Street Address
Address Line 2
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Armed Forces Americas
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State
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Current Position or Title
*
Which Certification Are You Applying For?
*
Select a Certification
Part I: Mindfulness Intensive Training
Part II: Mindfulness Teacher Certification
How Did You Hear About this Certification?
*
Mindfulness Meditation Background
What is Your Mindfulness Meditation Background to Date?
*
Please include: The number of months/years practicing; Frequency and duration of your regular practice; Style/techniques you normally practice; Trainings, classes or workshops you have attended
Have You Taken a Class with Mastermind Before?
*
Yes
No
Which Classes?
*
Why Are You Applying to the Mastermind Mindfulness Certification Program?
*
Which Populations are You Hoping to Serve?
*
Do You Have Physical, Mental, or Emotional Issues That Could Impact Your Ability to Complete This Program?
*
Yes
No
What Are They?
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
All applications will be reviewed and you will receive a request for an interview within one week of applying. If you are accepted, please know that your spot will only be secured upon complete payment or enrollment in monthly payment plan. There are no refunds or transfers within two weeks of training start date.
Phone
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First Name
*
Email
*
Email
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Contact Us
Address
3838 Oak Lawn Avenue Suite 400 Dallas TX, 75219
Phone
(214) 522-4575
Name
*
First
Last
Email
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Message
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Comments
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Corporate Contact
Your Name
*
First
Last
Phone
*
Email
*
Company
*
Role
*
How many employees do you have?
*
0-10
11-50
51-100
100-1001
1001-10,000
Over 10,000
What services are you interested in?
What are your goals for wellness programming?
Comments
Free Info Session Signup
Name
*
First
Last
Email
*
Which Session?
*
Saturday, January 23 @ 10AM Central
Tuesday, February 16 @ 6PM Central
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