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MindVision Booking and Enquiry form


This form is for you to make a booking for our MindVision workshop.

It also serves for you to make enquiries about MindVision. - fill in the form details and then click the “Send Enquiry Now” button. If you indicate you want an emailed copy you will receive an automated reply straight away and another from Fergus & Trijntje once they have received and read your booking details which will confirm your place at MindVision.

Middle Path MindVision Booking / Enquiry
Your Name: first name:    
last name:    
Your Gender: Female          Male          Other 
Your Date of Birth:            Day       Month       Year
Your email address:
Phone number/s:          
Address:
City:            State:              Postcode:
Country:
What do you want to change in your life?
Which MindVision dates would you prefer:
Are you taking any medication regularly?        
Please tell us which medications you are taking and how they affect you:

MindVision relies on everyone being able to feel their emotional state clearly. If you are taking any medication, such as an antidepressant, which subdues your emotions or interferes with your ability to know what you are feeling it is unlikely that you will be able to achieve any major benefits.
We need to know what medications you are taking so that we can be sure that MindVision is suitable for you.

Are you suffering from a medical condition which may cause
you distress during MindVision?          
Please tell us about the condition and how it affects you:
Any further questions, comments or concerns?
How did you hear about MindVision?
Do you have a website/webpage?
if so what's the address:
Are you on Facebook?
Any other internet links?
Do you want a copy of your booking details emailed to you?
        



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