Pyrenees Retreat: Enrolment application

Please complete this form in order to enrol on one of the Pyrenees retreats for People who Stutter
Please remember also to pay the deposit.

Name


  1. Which retreat would you like to enrol on?
    15-22 June 2018 Walk and Talk
    15-22 September 2018 Mindfulness retreat


  1. Address and postcode (if applicable)


  1. Contact telephone number(s)


  1. Email address


  1. You are....
    A person who stutters
    A partner of someone else on the retreat


  1. Do you have any health issues that we need to know about? If so, please give details below...


  1. Do you have any special requirements (or preferences) regarding accommodation and/or any special dietary requirements?


  1. For the "WALK AND TALK" week, please tick whichever of the following boxes apply to you...
    I am physically fit enough to do the mountain walks without putting my health at risk (click here for details of health/fitness requirements)
    I have read the walk and talk eligibility criteria and am confident that I fulfil them.
    I have read the walk and talk eligibility criteria and am not sure whether or not I fulfil them. (If this applies to you please provide details in question 10 below)


  1. For the MINDFULNESS retreat, please tick whichever of the following boxes apply to you...
    I have read some books about mindfulness and have a basic knowledge of what it entails
    I have completed an 8-week course in mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT)
    I have attended a Buddhist (or other similar) course which has taught me mindfulness-based meditation
    I have practiced a form of mindfulness-based meditation on a regular basis
    I am able to sit still for at least 30 minutes
    I am physically fit enough to do the mindful mountain walks without putting my health at risk (click here for details of health/fitness requirements)
    I have read the mindfulness week eligibility criteria and am confident that I fulfil them.
    I have read the mindfulness week eligibility criteria and am not sure whether or not I fulfil them. (If this applies to you please provide details in question 10 below)


  1. Please use this space for any questions you may have about the retreat you wish to take part in, and we will get back to you ASAP. Alternatively, if you wish, you can always phone Paul on +44 7986 153425 or +33 632 91 55 23

    Remember to press the SUBMIT button