CFT/CMT Workshop Registration Form

York MBSR

The Mindful Way to Reducing Stress

Registration Form
3 Day Skills Based CFT & CMT Workshop
With Dr Mary Welford
October 5-7 2011
York

Name *

First

Last

Title *

Phone Number *

Email *

Address *

Street Address
Address Line 2
City	County
Postal Code	Country

Price* *

*Price
Includes: VAT, refreshments, lunch and materials.
Excludes: Breakfast, evening meal and accomodation
Provisional Bookings will be held for two weeks from date of registration or until 30th September whichever date occurs first. Places will be allocated on receipt of full payment. Provisional bookings are no guarantee of places until payment is received in full. In the event that the event becomes fully booked, any remaining provisional places will be placed onto a reserved list and contacted in the case of any cancellations.

Payment Method *

All payments are due in advance of the workshop.
In the event of an invoicee not paying the due fee, the delegate becomes responsible for the full amount due

Receipt Required? *

Yes

Please complete the following details if you have requested an invoice to be raised

Organisation name

Invoicee Address

Street Address
Address Line 2
City	County
Postal Code	Country

Purchase Order Reference

Contact Name

Email

Additional Information

Any special requirements

For example dietary requirements, access etc - Please note a vegetarian option is provided as standard

Registration

Terms and Conditions *

I accept the terms and conditions of attendance and the cancellation policy

Date *

YYYY

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For all enquiries please
contact Robert on:

07730 059 634

Relax@YorkMBSR.co.uk

or click here

Correspondance Address

The Northern Centre for

Mindfulness and Compassion

Arkengarthdale Office

Forsyth Business Centre

Oakdale Road

Clifton Moor

York

YO30 4XL

Cancellation Policy
The registration fee will be refunded less a £15 administration charge if cancellations are received in writing to the Northern centre for Mindfulness and Compassion, at the address above, two weeks before the workshop date. Cancellations within two weeks of the event are charged the full registration fee.
In the event of cancellation of the workshop outside of our control we will not be held accountable for accommodation and/or travel costs incurred. However the workshop fees will be refunded.

Participant Agreement

Read the terms and conditions listed below carefully. In submitting your registration form you fully accept and agree to these terms and conditions.

TERMS AND CONDITIONS OF YOUR ATTENDANCE

I understand that these classes include music and slide projections at times, steps are taken to ensure that we keep noise exposure to a level that is reasonably practical; if that should cause me distress I will leave the room immediately and inform the programme organisers.

I further acknowledge that I am a healthy individual and I am physically and psychologically fit to participate in this programme. I know of no reason, nor have I been informed by my doctor or psychologist of any reason, why my participation in this programme would do me harm of any nature. If this does not accurately reflect my situation I agree that I will notify the programme organisers prior to the commencement of the programme.

I understand that although this event may raise emotional issues, it is not intended to provide a therapeutic environment or be a substitute for ongoing medical advice from a qualified medical practitioner, counselling or psychotherapy and any unresolved issues which may surface and which may warrant medical treatment, counselling or psychotherapy, will be at my own risk and expense.

I understand that neither KeyLine Consultancy Limited, York Stress and Trauma Centre nor any of its associated companies or their staff or representatives will be making any judgement as to my fitness to participate in this programme. However, if for any reason representatives of the organisers request me to leave the programme I will do so immediately without question or discussion.

CONFIDENTIALITY - I understand that during this workshop I may come into contact with personal information about other delegates. I respect that delegates, organisers and instructors must keep this personal information confidential except as maybe required by law.

I agree that any recorded or written material included as part of this event is protected by intellectual property laws, including copyright laws and may not be used without obtaining prior written permission from KeyLine Consultancy Limited, York Stress and Trauma Centre or its associated partners. As a participant, I agree not to record or make any reproduction of the whole or any part of the programme, materials or electronic files.

I understand that neither KeyLine Consultancy Limited, York Stress and Trauma Centre nor any of its associated companies or their staff or representatives shall not be liable for any default (or deemed to be in breach of contract) by reason of any delay due to circumstances beyond their control.

I acknowledge that I have carefully read and understood this agreement. I agree to release, indemnify and hold harmless KeyLine Consultancy Limited, York Stress and Trauma Centre and its associated companies, their agents, representatives and employees for any loss or damage I may suffer in any way associated with my participation in this programme.

Version 1.0 CFT Oct 2011

York MBSR is a partnership between KeyLine Consultancy Ltd and York Stress and Trauma Centre

Correspondance address: KeyLine Stress and Wellbeing Centre

Forsyth Business Centre, Oakdale Road, Clifton Moor, York, YO30 4XL