Meditation Months With Jaya Ashmore
Application Form
Name
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First Name
Last Name
Date of Birth
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Day
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Month
Year
Date
Email
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example@example.com
Have you participated in "Meditation months" course before?
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Yes (No need to fill out the form again -- Mark X in the boxes and only answer the last 4 questions at the bottom).
No (Please continue to fill out the form).
Have you practiced meditation before?
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Yes
No
If you have meditated before, please describe--which style of meditation, book, recording, technique, teacher and/or personal experiences have been helpful? If you haven't meditated before, what interests you about meditation now?
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Do you currently have a daily practice? If so what? when? where? how? Please briefly describe.
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What is your favorite kind of meditation?
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Previous retreats with Jaya -- when, where, how many days and any comments you would like to share about your retreat experience:
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How did you hear about Meditation months ?
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Jaya's website
News letter
A friend
Other
Please write 3 reasons (or more) why you want to join:
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What challenges do you look forward to and is there anything you feel concerned about in this course?
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You are applying for:
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Joining live meditations at scheduled times, access the recordings, and participate in the online forum ($25-$50 sliding scale)
Joining the meditations or listen to the recordings but do not participate in the online forum--links and recordings sent directly to your email address ($50-$75 sliding scale)
Only access the recordings of the sessions by email ($25-$50 sliding scale)
Do you have any past or present sleep or eating issues, abuse history or issues, suicidal thoughts or other psychological imbalances? (If yes, please give details of occurrences, treatment and medications if any.)
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If you are accepted, you will be asked to write a paragraph about yourself, to introduce yourself to the community. Please write a paragraph here that you could use for that if you are accepted. Please include your name, you might include country, meditation experience, your particular interest in meditation at this time, what you wish to bring to and learn from in the course - we will share this in the group with your name.
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"I agree that I have and maintain full responsibility for my physical and mental health and well-being."
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I Agree
"I commit to keep all communications from the course confidential: I will not share course materials nor the sharing of other participants with anyone else."
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I commit
I agree to the privacy policy on Jaya's website (we only use your data for what you are signing up for but all the companies that we use have their own privacy policies)
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I Agree
Submit
Should be Empty: