Application to Receive the Five Mindfulness Trainings

Please complete the form below to confirm that you would like to receive the transmission of the Five Mindfulness Trainings.

You can read about the Five Mindfulness Trainings by clicking this link

Please note that it is very important to attend the “Presentation of the Five Mindfulness Trainings” event before submitting the form.

First Name*
Surname*
Email*
Enter Email Confirm Email
Address*
We need this to be able to post you your certificate for the transmission

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Have You Received the Five Mindfulness Trainings Before?*
Please answer yes or no
- Yes
- No
Your Previous Transmission*
Please tell us which of the Five Mindfulness Trainings you have already received. Select all that apply below.
Previous Dharma Name
Please tell us the Dharma Name you were given at the previous transmission. Leave blank if you can’t remember it.
Do you intend to receive all five of the trainings?*
Do you intend to receive all five of the trainings?
- Yes
- No
Your Transmission*
Please tell us which of the Five Mindfulness Trainings you would like to receive. Select all that apply below.
Your Aspiration*
Please share with us in 150 to 200 words your aspiration for receiving the transmission.
Any Other Information
Is there any other information you would like to give us at this time?