The Untethered Soul, course Registration Application Form

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This course is offered by Clear Mind, Open Heart and taught by Laurie Arron live online via Zoom, from Feb 16 - Apr 6, 2022. For more info: http://clearmindopenheart.ca/untetheredsoulcourse/.

THE COURSE IS NOW FULL. IF YOU WOULD LIKE TO BE PLACED ON THE WAIT LIST, PLEASE FILL OUT THIS FORM. PLEASE DO NOT SEND PAYMENT AT THIS TIME.

We will read The Untethered Soul as part of the course. Please obtain the book in advance and read the Intro and chapters 1-3 for the first class.

Email *

First Name *

Last Name *

Phone number *

Meditation Experience *

No meditation experience

Little meditation experience

Some meditation experience

I practice meditation regularly

Other:

Why are you taking this course? *

How did you hear about this course? *

Clear Mind, Open Heart

True Peace

MPC (Mindfulness Practice Community of Toronto)

Consciousness Explorers Club

Luminous Ground

Mindfulness Everyday

Dharma Friends

Celtic Mindfulness / Untethered Soul Book Club

Other Meditation Group

Eventbrite

Social Media

Word of Mouth

Other:

Do you suffer from any mental health issues? If yes, please describe. *

Waiver

I am aware that this program is not therapeutic and is not a substitute for therapy, and that the teacher, Laurie Arron, is not a mental health professional. I am responsible for my well-being and I will not hold the teacher responsible for any injuries or harm arising from my participation in this program.

If you would like to speak to the teacher in between sessions, it is best to email them. They may not be able to get back to you immediately. In the case of a crisis or emergency, please go to the nearest emergency room or call 911.

I have read and understand the above waiver. *

Yes

Required

Course Fees

Half of all course fees are donated to non-profit meditation groups. The fee is based on a sliding scale:
Sustainer rate - Cdn $225
Benefactor rate - Cdn $325
Scholarship rate - Cdn $95
If you are unable to afford even the scholarship rate, bursaries are available. Apply at https://forms.gle/usMm5r4eAxhqS1B39.

To which non-profit meditation / mindfulness community do you wish your fees to be donated? *

Plum Village

True Peace

MPC (Mindfulness Practice Community of Toronto)

Dharma River Mindful Living Community

Consciousness Explorers Club

Mindfulness Everyday

Dharma Friends

Celtic Mindfulness

Up to Laurie

Which rate are you able to pay? (You can choose Other and insert whatever amount you wish from $95 up. If you cannot afford $95, please apply for a bursary.) *

Sustainer rate - Cdn $225

Benefactor rate - Cdn $325

Scholarship rate - Cdn $95

I cannot afford the $95 scholarship rate and will apply for a bursary at https://forms.gle/usMm5r4eAxhqS1B39

Other:

How will you pay the course fee? (Please wait for an email saying space is available before paying.)

e-transfer (preferred if you are in Canada)

PayPal

I am unable to pay by etransfer or PayPal. Please contact me.

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