Test Registration

Name *

First

Last

Email *

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Address *

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Address Line 2

City

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Postal Code

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Phone number *

How did you hear about this *

Email from Kate Mitcheom Heart-Based Mindfulness
Email from Lucia or from www.luciamcbee.com
Email/website of Brown Mindfulness Center
Saw on Kate's website
Friend told me
Other

Please explain. Thank you!

What drew you to this Retreat? (Check all that apply) *

Silent Retreat
Mindfulness
MBSR certification requirement
Other

Please explain. Thank you!

What to expect on a Silent Retreat is a helpful document that explains what happens on a Silent Retreat.

Please check below to indicate you have read "What to expect on a Silent Retreat". (required) *

Yes, I know what to expect.

Total January 2022 Online Silent Retreat Cost= $850

Refunds: If cancelled up to December 20, 2021, we will deduct a $50 cancellation fee. If cancelled on or after December 20, NO REFUNDS will be given.

I plan to pay by *

Venmo:@Kate-mitcheom
Check (checks are preferred)
Credit Card

See Refund policy above.

Your check for $850 is due following registration. *

I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.

Please make out your $850.00 check to Kate Mitcheom and mail to:

Kate Mitcheom

17 Haycock Point Road

East Branford, CT 06405

Pay by credit card *

Price: $ 850.00

You will be sent to Paypal to complete your purchase. You may choose "Pay with debit or credit card" and check out as Guest, if you wish. No need to have a PayPal account.

Total by credit card *

$ 0.00

Name

Heart-Based Mindfulness

Contact Kate · 203-887-8932