Tuesday evenings June to August

Upcoming MBSR program in North Vancouver

Tuesday evening MBSR program starting June 20th, 2017:

To secure a spot in the program, please fill the form below, the program tends to fill up with a waiting list.

Participation in this MBSR program involves meeting for nine sessions, plus, an info/orientation session. Here is the breakdown of hours:

1. One info/orientation session, FREE and open to all (1.5 hrs)
2. Eight evening sessions (2.5 hrs with exception to first & last sessions that are 3 hrs).
3. One All-Day session (7 hrs).

All MBSR participants are required to attend the info/orientation session (free and open to all). The total hours that you will be getting, including the info session, are 29.50. Please see detailed schedule/location below.

A safe environment will be created to systematically explore the use of mindfulness to deal with pain, illness, and the demands of daily life. This will include guided instructions, short lectures, and space for group sharing and questions.

The program requires a commitment to attend the sessions and engage in the daily practices given.

Location:

John Braithwaite Community Centre
145 1st St West
North Vancouver, BC V7M 1B1

NOTE: If you are driving, there is FREE parking in the area (in addition to the paid parking lots). If you are using transit, the location is near the SeaBus.

All regular program sessions are held at John Braithwaite Community Centre, North Vancouver, with the exception to the All-Day session. The All-Day session is on May 13, 2017. It will be at Parkgate Community Centre, 3675 Banff Court, North Vancouver. The detailed schedule of dates/locations will be e-mailed to you when you receive your registration confirmation by e-mail.

MBSR Schedule (2017):

Session

Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
All-Day
Session 7
Session 8

Date

Tuesday, June 20
Tuesday, June 27
Tuesday, July 4
Tuesday, July 11
Tuesday, July 18
Tuesday, July 25
Saturday, July 29
Tuesday, August 1
Tuesday, August 8

Time

6:00 pm - 9:00 pm *(Three hour class)
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
9:30 am - 4:30 pm ** (Extended session)
6:00 pm - 8:30 pm
6:00 pm - 9:00 pm * (Three hour class)

*Please make note of the dates in asterisks as they deviate from the regular schedule.
** All day session will be held on Saturday, July 29 in Parkgate Rec Center, 3675 Banff Court, North Vancouver.

Info/orientation session:

All MBSR participants are required to attend an info/orientation session. If you are unable to attend any of these info/orientation dates, please contact me to make alternative arrangement (info@drkasimalmashat.com).

Please choose ONE of the following dates/location (indicate your choice in the registration form at the bottom of this page):

Date	Time	City	Address	Registration status
Monday, May 15th, 2017	7:00 PM to 8:30 PM	Vancouver	Hillcrest Community Centre, 4575 Clancy Loranger Way	Closed (past event)
Tuesday, May 30th, 2017	7:00 PM to 8:30 PM	North Vancouver	John Braithwaite Community Centre, 145 1st St We	Closed (past event)
Saturday, June 17th, 2017	10:30 AM to noon	West Vancouver	St. Stephen's Pavillion, 885 22nd Street	Closed (past event)

Fee:

$450 (includes MBSR booklet and mindfulness audios)

Helpful Fee Info:

I am a Registered Psychologist with the College of Psychologists of BC. Some Extended Health plans cover Psychologist Services. Otherwise, non-reimbursed Psychologist fees are tax deductible according to Canada Revenue Agency.

Payment method:

INTERAC e-Transfer (preferred), cheque, money order, or cash.

For INTERAC e-Transfer use info@drkasimalmashat.com.

Payment Options:

Applications will be reviewed within two business days of submission. If there is still space in the program and your application is accepted, you will receive a confirmation by e-mail of your registration. At that time, a minimum of $50 is due. You can then pay the remaining balance by June 17, 2017. Or, you can just make one payment of $450 upon receiving an e-mail confirmation from me for your registration.

You can also contact me if you need to make a special payment arrangement.

Refund policy:

Refunds for this MBSR program are provided for cancellations made prior to the MBSR session #1 (i.e., before June 20, 2017), less a $50 processing fee. After that, no refunds will be issued unfortunately. Thank you for your understanding.

How to register:

To apply for this program, please fill the form below. Your application will then be reviewed, and you will be notified of your registration status within two business days.

If your registration form is received after the class is full, you will be placed on a waiting list.

The information below is only viewed by me (Dr. Kasim Al-Mashat) and is confidential. As a Registered Psychologist, I adhere to the highest standards of practice.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

If you have attended one of the previous MBSR info sessions, please indicate when/where. Otherwise, indicate "not applicable". *

What is your date of birth (Day/Month/Year)? *

Is it okay to leave you a voicemail on the phone number you have listed (if needed)? *

Address *

How did you hear about this? (Please specify) *

Any previous meditation experience? *

Do you have close friend(s) and/or family in the area? *

How is the quality of your sleep? (please describe) *

Do you take prescription medication? (If yes, please list) *

Have you experienced any recent and significant changes due to: *

Medical/health matters. Psychological matters. None

If applicable please describe any recent significant medical and/or psychological changes. Otherwise, indicate "not applicable". *

Any previous overnight hospitalization? *

If you answered yes to the above question, please elaborate. Otherwise, indicate "not applicable". *

Have you experienced any of the following in the past (check all that apply): *

Considered and/or attempted suicide. Have urges to harm someone. Have experienced panic attacks. No, I have not experienced any of the above.

Please elaborate on the above question, or indicate "not applicable" if you selected "No". *

Do you have a history of substance abuse? *

If you answered yes to the above question, please describe how often and what type of substance(s). Otherwise, indicate "not applicable". *

What do you consider to be your strengths? (please list at least three) *

Emergency contact name *

Emergency number *

GP and clinic name *

Currently seeing a counsellor or psychologist? *

Method of payment? *

Payment options for the Tuesday MBSR program starting June 20, 2017: *

Anything else you want me to know: *

Refunds for this MBSR program are provided for cancellations made prior to session #1 (i.e., by Tuesday June 20, 2017), less a $50 processing fee. After that, no refunds will be issued unfortunately. Thank you for your understanding. *

Yes, I have read and agreed to the refund policy

Please note: If you do not hear back from me by Tuesday, June 20th, it means that your online submission did not go through and I did not receive it. You can double check by e-mailing me at info@drkasimalmashat.com *

Yes, I understand.

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