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3-Day Vipassana
Application
To apply for this course, AFTER READING "ABOUT THIS COURSE" AND "ABOUT VIPASSANA" PAGES FULLY, please fill out the information below, carefully and honestly.
I have read "About this Course" and "About Vipassana Meditation" thoroughly, agree to the course guidance, rules, and schedule, and certify that I am in every way mentally and physically ready to engage in this program.
I am applying for the following 3-day course for mental health or social program workers (choose one, only)
December 31 - January 1
February 4-6
March 4-6
April 1-3
April 22-24
First Name
Last Name
Email
Phone
Age
Address
Gender
On a scale from 0 to 10, how committed are you to your own health and happiness?
10
9
8
7
6
5
4
3
2
1
0
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