Mindful Relating - Masterful Living Enrollment Questionnaire

"Mindful Relating. Masterful Living." Enrollment Questionnaire

The following brief questionnaire is for those who are planning to attend the "Mindful Relating. Masterful Living" program at In Yoga of Terre Haute beginning on Sunday, January 22, 6:30 - 8:00 p.m. Your answers will help us to create a beneficial and enjoyable experience for you and other participants. Thank you - and we look forward to seeing you on January 22nd!

Your Name *

First

Last

Your Email *

Phone *

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If you are enrolling with another person, please indicate their relationship to you: *

spouse

family member

coworker

friend

Other

Name of person attending with you: *

Email address of person attending with you: *

What are the most important outcomes you would like to achieve as a result of participating in this program? *

What are some of your biggest relationship challenges? *

Do you like to have fun? *

Yes, of course

No, not really

What activities do you regularly engage in that you consider fun? *

Do you enjoy participating in meaningful conversations? *

Yes

No

Are you willing to take specific actions between sessions? *

Yes

No

What do you NOT enjoy doing during a group program (e.g. role playing)?

Which of the following activities do you frequently engage in? *

yoga

resistance training

zumba

running

bicycling

fitness walking

meditation

prayer

sports

How would you like to pay for the session? *

I'll pay at the door for each session

I'll pay in advance using a credit card

To pay in advance using a credit card, please visit http://www.relationshipfitnessonline.com and click on "Local Events." Scroll down to see payment options.