Application Form for the Interpersonal Mindfulness Program (IMPT) Teacher Training – October 10–18, 2025 – Santa María de Huerta (Soria, Spain)

PROGRAM

Course Fee

  • Pre-registration: €400 before March 31, 2025
  • Remaining payment of registration (€1,000) due by July 30, 2025

Cancellation Policy (if the participant cancels):

  • Before May 30, 2025: 100% refund minus €80 for organizational and administrative costs
  • Before July 30, 2025: 50% refund
  • After July 30, 2024: No refund (by this date, the major organizational expenses will have been incurred)

Thank you for completing this online form. We will send you an acknowledgment of receipt as soon as possible. Your application will then be reviewed by the teaching team, and we will respond within 8 to 10 days.

*(This application may take more than ten minutes to complete.)

* Indicates that the question is mandatory

    Fields marked with * are required

    PERSONAL INFORMATION

    First Name*

    Last Name*

    Address (street, avenue, square)*

    Municipality*

    City*

    Postal Code*

    Country*

    Phone*

    Email*

    Emergency Contact Phone*

    Native Language (You can mark more than one option):

    SpanishEnglishI am not a native English speaker but I can understand and express myself in English

    Do you have any physical or mental conditions that might affect your participation in the course?*

    YesNo

    Please describe:

    Do you have any food or other allergies?*

    Please describe:

    PROGRAM PARTICIPATION REQUIREMENTS

    1. Do you have a regular meditation practice?*

    YesNo

    Please describe:

    2. I am a teacher of:*

    MBSRMBCTOther program

    Note: Teachers or facilitators of other training programs will be considered on a case-by-case basis.

    Please describe:

    3. Profession*

    4. Have you participated in more than two silent retreats?*

    YesNo

    At least 7 daysAt least 5 days

    Please describe dates, location, duration, and teacher:

    5. Have you participated in at least two Conscious Dialogue retreats?*

    YesNo

    Please describe dates, location, duration, and teacher:

    6. Have you participated in at least one 8-week Interpersonal Mindfulness program?*

    YesNo

    7. Have you taught at least 3 cycles of MBSR/MBCT?*

    YesNo

    I have facilitated other training programs

    Please describe:

    ADDITIONAL INFORMATION

    Is there any circumstance you would like to share as important for your training that we haven’t asked about?*

    Please describe:

    MY MOTIVATION

    My motivation to participate in this training*:

    I accept the privacy policy

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