Registration Mindfulness (MBSR) Training

Starting date of Training*
Preferred date & time for individual training
Name*
First Name Family Name
Telephone Number*
E-mail*
Address*
Street & Number City Postal Code
Profession*
Date of Birth*

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Registration motive*
Any questions/remarks of importance to the trainer?
Promotion Code
Terms and Conditions*
- I agree with the Terms and Conditions
When sending this registration form, you agree with Annes Ademruimte's General Terms & Conditions.
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