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

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:

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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 Insight 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:

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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*:

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+ Disclaimer. I accept the above terms and conditions.

Understanding the voluntary nature of my participation in the work, programs, and activities offered by EFSYP, I release and discharge EFSYP and its agents and employees from all causes of action, liability, and claims for all personal injuries, illnesses, property damage, or death that may occur now or in the future, caused by or directly or indirectly related to any work I may perform or any activity I engage in during my participation in this EFSYP program or my stay at the center. For the period covered by this program, by clicking the checkbox below, I agree that I am covered by medical insurance and acknowledge that medical insurance is not the responsibility of the ESPACIO DE FORMACIÓN EN SALUD Y PSICOTERAPIA.