Registration Form for
A Year of Mindfulness
With The Pollination Project

Important: The following questions are purely for the purpose of supporting practice in the program. Your answers aid the design of the curriculum to meet the unique needs of each cohort. Answers to the questions will remain confidential (available only to the teacher).

Your email address will be used for the following purposes:

  1. Emails regarding registration and guidelines about the Year Long Program. Sending links to the course workbook, free guided meditations and readings.

  2. Newsletter related to updates, other workshops, retreats or online events.

  3. Your email address will not be shared with any third party.

Name *
Eg: He, She, They, Ze or Other
Section 2: Meditation and Retreat Experience
Section 3: Reflective Questions
(Yes/No) If yes, please describe. Please note that your stating 'yes' will not limit your participation. We wish to do our best to welcome people from diverse abilities and experiences at this program. Your answer simply helps us plan better so that we can offer the resources and facilities that will support you.