ONLINE Mindfulness for Adults • Class Registration • JULY 2020

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Please fill out this form for pre-registration for Koru Mindfulness Online for Adults with Myra Smith. This course is for adults ages 18 and up.

Before completing this form, please make your tuition payment or scholarship request.

Tuition payments can be made via Venmo.com to @MyraJeanSmith or to Paypal.com to the address myrajeansmith@gmail.com.

The link for scholarship requests is on the
Mindful HIgh School website at http://wwwmindfulhighschool.com

Tuition is on a SLIDING SCALE of $75 - $130.

Each purchase of a course purchases a scholarship for a student in need.

Classes are on Thursday evenings in July 6:30 - 7:45pm EST.
~JULY 9
~JULY 16
~JULY 23
~JULY 30

It is important that you are able to attend all four classes.

All classes meet on the video conferencing platform Zoom.

Once I receive your tuition payment and you complete this form, you will receive a confirmation email with the link to our ZOOM class, and your registration for the Koru app and details about the course texts.

Name *

Email *

Phone Number ***I will only call you if you register for a class and I am not hearing back from you via email. *

Classes are on Thursday evenings in JULY 6:30 - 7:45pm EST. JULY 9, 16, 23, 30 *

YES! I can you attend all 4 classes.

I may have to miss a class due to travel. I will let you know in advance. (Classes can be recorded)

Other:

Required

***Please pay tuition or request a scholarship before completing this form. I : *

Please tell me how you found out about the class. *

A friend sent me one of your emails

Via the Mindful High School Website

Instagram

Facebook

Nextdoor

Other:

So you can stay informed about upcoming free meditation events, online classes, as well as other opportunities and resources, may I add you to my mailing list? *

Yes

I already receive emails.

Not at this time.

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