Zoom Event Registration

Contact Information

What are you registering for?

Weekend (Jan 30/31)Advanced Day (Feb 7) OnlyBoth Weekend and Advanced Day

Name

Email

Telephone Number

Address

Financial Wellbeing

If you cannot afford to attend at this time, please do not put yourself at financial risk.

Are you financially stable?

YesNo

Mental Wellbeing

This workshop explores mindfulness and self development, as such it is best suited for those who are emotionally and mentally healthy.

Are you currently seeing a mental health professional?

YesNo

Workshop Policy

On receiving this completed form, we require a minimum deposit payment of €500 to confirm your application. Eight weeks prior to the event, we require an additional €500 and any outstanding balance will be required four weeks prior to the workshop. The first and second mandatory deposits are neither refundable nor transferable. Any amount in excess of these amounts can only be refunded up to two weeks prior to the workshop. Within and after these final two weeks, no refund or transfer is allowed. Please note that your full investment must be submitted prior to the workshop. Thank you for your cooperation and understanding.

I have read and accept these conditions.

By checking this box, and submitting this application, you agree to assume all risks incurred in participating in the workshop including physical injury; and agree to hold Derek OʼNeill and any associated entities harmless for such injury. You further agree that your image and voice, may be recorded and used as Derek, in his sole discretion, deems fit. Please note, we highly recommend that anyone with a history of mental instability, receiving psychiatric treatment or actively taking anti-psychotic medication please seek the advice of your doctor and in doing so attend the workshop at your own risk.

**Please Note: The form will not send unless you check the box above.