{"id":30871,"date":"2019-07-03T01:04:38","date_gmt":"2019-07-03T01:04:38","guid":{"rendered":"https:\/\/mindfulnessinschools.org\/?page_id=30871"},"modified":"2025-06-11T19:34:39","modified_gmt":"2025-06-11T19:34:39","slug":"breathe-application","status":"publish","type":"page","link":"https:\/\/mindfulnessinschools.org\/form\/breathe-application\/","title":{"rendered":"Teach .breathe Application"},"content":{"rendered":"<h2 class=\"page-title text-align-center\"><strong><span style=\"color: #274368;\">Teach<\/span> <span style=\"color: #ff0000;\">.<\/span><span style=\"color: #274368;\">breathe<\/span><\/strong> Application<\/h2>\n<h3 style=\"text-align: center;\">Complete the Application Form<\/h3>\n<p style=\"text-align: center;\">Please read each question carefully, and respond as <strong>fully<\/strong> and <strong>accurately<\/strong> as possible.<\/p>\n<p style=\"text-align: center;\">Application form must be <strong>completed by the applicant<\/strong> and not someone else on their behalf.<\/p>\n<div class=\"form-wrap\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_110' style='display:none'><div id='gf_110' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_110' id='gform_110'  action='\/wp-json\/wp\/v2\/pages\/30871#gf_110' data-formid='110' novalidate><div id=\"payments-sdk__contingency-lightbox\"><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_110' class='gform_fields top_label form_sublabel_above description_below validation_below'><li id=\"field_110_6\" class=\"gfield gfield--type-select gfield--input-type-select wp_course_dates gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_6'>Please select the Teach .breathe course you are applying for<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_110_6' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select course<\/option><option value='Teach .breathe \u2013 ONLINE \u2013 04 Feb 2026' >Teach .breathe \u2013 ONLINE \u2013 04 Feb 2026<\/option><option value='Teach .breathe \u2013 ONLINE \u2013 06 May 2026' >Teach .breathe \u2013 ONLINE \u2013 06 May 2026<\/option><\/select><\/div><\/li><li id=\"field_110_129\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"specialbox grey\" style=\"margin:0;text-align:center\">Please select a course from the drop down menu before proceeding with your application.<\/div><\/li><li id=\"field_110_89\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label\">Read the delivering .breathe <a href=\"https:\/\/mindfulnessinschools.org\/terms-and-conditions-teach-breathe\/\" target=\"_blank\">Terms and Conditions<\/a><\/label>\n<p><label class=\"gfield_label\">Read the MiSP one-day course <a href=\"https:\/\/mindfulnessinschools.org\/terms-conditions\/terms-conditions-attending-misp-one-day-courses\/\" target=\"_blank\">Terms and Conditions<\/a><\/label><\/p><p><label class=\"gfield_label\">Read the .breathe <a href=\"https:\/\/mindfulnessinschools.org\/prerequisites\/prerequisites-for-teach-breathe-training\/\" target=\"_blank\">prerequisites<\/a><\/label><\/p><\/li><li id=\"field_110_109\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Terms and Conditions<\/h2><div class='gsection_description' id='gfield_description_110_109'>I have read, understand and fully agree to the Terms and Conditions and prerequisites for taking part in this training course and confirm that I meet these prerequisites and agree to the ongoing commitments as a .breathe teacher as described.<\/div><\/li><li id=\"field_110_124\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please confirm you have read the Terms &amp; Conditions for delivering .breathe.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_124'><li class='gchoice gchoice_110_124_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_124.1' type='checkbox'  value='I have read the Terms &amp; Conditions for delivering .breathe.'  id='choice_110_124_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_124_1' id='label_110_124_1' class='gform-field-label gform-field-label--type-inline'>I have read the Terms &amp; Conditions for delivering .breathe.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_125\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please confirm you have read the MiSP one-day course Terms &amp; Conditions.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_125'><li class='gchoice gchoice_110_125_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.1' type='checkbox'  value='I have read the MiSP one-day course Terms &amp; Conditions.'  id='choice_110_125_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_125_1' id='label_110_125_1' class='gform-field-label gform-field-label--type-inline'>I have read the MiSP one-day course Terms &amp; Conditions.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_126\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please confirm that you have read the .breathe prerequisites.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_126'><li class='gchoice gchoice_110_126_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_126.1' type='checkbox'  value='I have read the .breathe prerequisites.'  id='choice_110_126_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_126_1' id='label_110_126_1' class='gform-field-label gform-field-label--type-inline'>I have read the .breathe prerequisites.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_119\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Your Details:<\/h2><\/li><li id=\"field_110_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_1'>Name (First name and Surname. This will be the name used on your certificate)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_110_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_19'>Email address for course communication<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_110_19' type='text' value='' class='medium'  aria-describedby=\"gfield_description_110_19\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_110_19'>Please check you have typed this correctly.<\/div><\/li><li id=\"field_110_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_20'>House number or name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_110_20' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_3'>Street<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_110_3' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_4'>Town or City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_110_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_5'>County or state<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_110_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_7'>Postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_110_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_9'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_110_9' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'>Please select<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='' >\u2014<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/li><li id=\"field_110_78\" class=\"gfield gfield--type-select gfield--input-type-select gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_78'>Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_78' id='input_110_78' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Please select<\/option><option value='Eastern England' >Eastern England<\/option><option value='East Midlands' >East Midlands<\/option><option value='London' >London<\/option><option value='North East England' >North East England<\/option><option value='North West England' >North West England<\/option><option value='South East England' >South East England<\/option><option value='South West England' >South West England<\/option><option value='West Midlands' >West Midlands<\/option><option value='Yorkshire and the Humber' >Yorkshire and the Humber<\/option><option value='Scotland' >Scotland<\/option><option value='Wales' >Wales<\/option><option value='Northern Ireland' >Northern Ireland<\/option><option value='Channel Islands' >Channel Islands<\/option><\/select><\/div><\/li><li id=\"field_110_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_24'>Home telephone number (please include country code if outside the UK)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_110_24' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_25'>Mobile telephone number (please include country code if outside the UK)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_110_25' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection margin-bottom-reduce field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Emergency Contact while on the course:<\/h2><div class='gsection_description' id='gfield_description_110_13'>Please give details of an emergency contact who will be available while you are on the course.  <\/div><\/li><li id=\"field_110_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_17'>Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_110_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_18'>Number (Landline)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_110_18' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield_left_align gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_76'>Number (Mobile)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_110_76' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_80\" class=\"gfield gfield--type-section gfield--input-type-section gsection margin-bottom-reduce field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Your Employment:<\/h2><\/li><li id=\"field_110_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_26'>Your Profession<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_110_26' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_27'>Your Employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_110_27' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_92\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_92'>Your Employer&#039;s Postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_110_92' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Is your employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_39'>\n\t\t\t<li class='gchoice gchoice_110_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='A maintained school (incl. grammar school) or academy chain in the UK'  id='choice_110_39_0'    \/>\n\t\t\t\t<label for='choice_110_39_0' id='label_110_39_0' class='gform-field-label gform-field-label--type-inline'>A maintained school (incl. grammar school) or academy chain in the UK<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='An independent school in the UK'  id='choice_110_39_1'    \/>\n\t\t\t\t<label for='choice_110_39_1' id='label_110_39_1' class='gform-field-label gform-field-label--type-inline'>An independent school in the UK<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_39_2'>\n\t\t\t\t<input name='input_39' type='radio' value='A council, LEA or other governmental body'  id='choice_110_39_2'    \/>\n\t\t\t\t<label for='choice_110_39_2' id='label_110_39_2' class='gform-field-label gform-field-label--type-inline'>A council, LEA or other governmental body<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_39_3'>\n\t\t\t\t<input name='input_39' type='radio' value='A non-UK school or other international educational body'  id='choice_110_39_3'    \/>\n\t\t\t\t<label for='choice_110_39_3' id='label_110_39_3' class='gform-field-label gform-field-label--type-inline'>A non-UK school or other international educational body<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_39_4'>\n\t\t\t\t<input name='input_39' type='radio' value='Other (please specify)'  id='choice_110_39_4'    \/>\n\t\t\t\t<label for='choice_110_39_4' id='label_110_39_4' class='gform-field-label gform-field-label--type-inline'>Other (please specify)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_39_5'>\n\t\t\t\t<input name='input_39' type='radio' value='I am self-employed'  id='choice_110_39_5'    \/>\n\t\t\t\t<label for='choice_110_39_5' id='label_110_39_5' class='gform-field-label gform-field-label--type-inline'>I am self-employed<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_40'>Please specify<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_110_40' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_93'>Name of school or place of work<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_110_93' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_94'>Postcode of school or place of work<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_110_94' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_100\" class=\"gfield gfield--type-section gfield--input-type-section gsection margin-bottom-reduce field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Funding:<\/h2><\/li><li id=\"field_110_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio margin-vertical-8 gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How is your attendance being funded?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_10'>\n\t\t\t<li class='gchoice gchoice_110_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Self-funded'  id='choice_110_10_0'    \/>\n\t\t\t\t<label for='choice_110_10_0' id='label_110_10_0' class='gform-field-label gform-field-label--type-inline'>Self-funded<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='MISP supported place'  id='choice_110_10_1'    \/>\n\t\t\t\t<label for='choice_110_10_1' id='label_110_10_1' class='gform-field-label gform-field-label--type-inline'>MISP supported place<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='Other'  id='choice_110_10_2'    \/>\n\t\t\t\t<label for='choice_110_10_2' id='label_110_10_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_74\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"specialbox grey\" style=\"margin:0; text-align:center;\">To secure a place payment is due within <strong>2 days<\/strong> of receiving the invoice.  If you are applying for a Private Group place, you will not be invoiced.<\/div><\/li><li id=\"field_110_73\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"specialbox grey\" style=\"margin:0; text-align:center;\">To secure a place payment is due within <strong>2 weeks<\/strong> of receiving the invoice.  If you are applying for a Private Group place, you will not be invoiced.<\/div><\/li><li id=\"field_110_98\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"specialbox grey\" style=\"margin:0; text-align:center;\">To secure a place payment is due within <strong>2 weeks<\/strong> of receiving the invoice.  If you are applying for a Private Group funded place, you will not be invoiced.<\/div><\/li><li id=\"field_110_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_72'>Enter the code received from MiSP<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_110_72' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_66'>Organisation name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_110_66' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_67'>Organisation address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_110_67' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_68'>Contact name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_110_68' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_75\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_75'>Contact email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_75' id='input_110_75' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_110_71\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"margin-bottom:0;\">Please provide the name and address of the organisation and the contact name and email address of the person we should send the invoice to:<\/p><\/li><li id=\"field_110_81\" class=\"gfield gfield--type-section gfield--input-type-section gsection margin-bottom-reduce field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Other Information:<\/h2><\/li><li id=\"field_110_85\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please confirm you are over 18 years of age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_85'><li class='gchoice gchoice_110_85_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_85.1' type='checkbox'  value='I confirm that I am over 18 years of age'  id='choice_110_85_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_85_1' id='label_110_85_1' class='gform-field-label gform-field-label--type-inline'>I confirm that I am over 18 years of age<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_79\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please confirm your level of English<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_79'><li class='gchoice gchoice_110_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='I confirm that I am able to speak and understand English to an Upper Intermediate Level, i.e. I am able to interact fluently with native speakers, communicate effectively and understand everyday language without the aid of an interpreter.'  id='choice_110_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_79_1' id='label_110_79_1' class='gform-field-label gform-field-label--type-inline'>I confirm that I am able to speak and understand English to an Upper Intermediate Level, i.e. I am able to interact fluently with native speakers, communicate effectively and understand everyday language without the aid of an interpreter.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_91\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label\">While this course is very much an introduction to mindfulness, there will periods during the day when we engage in brief mindfulness practices. If there are any aspects of your life, e.g. recent mental health issues, trauma or major life events, that you feel may affect your participation in, or experience of, the course please do let us know by contacting support@mindfulnessinschools.org. Please be assured that any personal information you disclose will be treated in the strictest confidence.<\/label><\/li><li id=\"field_110_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have any physical illness (including allergies) or other issues that may make sitting, standing, walking or doing simple mindfulness practices difficult for you? If yes, please tell us about it.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_49'>\n\t\t\t<li class='gchoice gchoice_110_49_0'>\n\t\t\t\t<input name='input_49' type='radio' value='Yes'  id='choice_110_49_0'    \/>\n\t\t\t\t<label for='choice_110_49_0' id='label_110_49_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_49_1'>\n\t\t\t\t<input name='input_49' type='radio' value='No'  id='choice_110_49_1'    \/>\n\t\t\t\t<label for='choice_110_49_1' id='label_110_49_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_50\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_50'>Please explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_50' id='input_110_50' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you currently taking any medication which could have an impact on your participation on the course? If yes, please provide more details below.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_52'>\n\t\t\t<li class='gchoice gchoice_110_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='Yes'  id='choice_110_52_0'    \/>\n\t\t\t\t<label for='choice_110_52_0' id='label_110_52_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='No'  id='choice_110_52_1'    \/>\n\t\t\t\t<label for='choice_110_52_1' id='label_110_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_53\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_53'>Please explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_53' id='input_110_53' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have any difficulty with sight or hearing that we should know about? If yes, please tell us about it.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_54'>\n\t\t\t<li class='gchoice gchoice_110_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Yes'  id='choice_110_54_0'    \/>\n\t\t\t\t<label for='choice_110_54_0' id='label_110_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='No'  id='choice_110_54_1'    \/>\n\t\t\t\t<label for='choice_110_54_1' id='label_110_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_55\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_55'>Please explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_55' id='input_110_55' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >To my knowledge, there are no personal mental health issues, trauma or major life events that are likely to affect my experience of this course.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_56'>\n\t\t\t<li class='gchoice gchoice_110_56_0'>\n\t\t\t\t<input name='input_56' type='radio' value='I agree - there are NO personal mental health issues, trauma or major life events that are likely to affect my experience of this course.'  id='choice_110_56_0'    \/>\n\t\t\t\t<label for='choice_110_56_0' id='label_110_56_0' class='gform-field-label gform-field-label--type-inline'>I agree - there are NO personal mental health issues, trauma or major life events that are likely to affect my experience of this course.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_56_1'>\n\t\t\t\t<input name='input_56' type='radio' value='I disagree - there ARE personal mental health issues, trauma or major life events that are likely to affect my experience of this course.'  id='choice_110_56_1'    \/>\n\t\t\t\t<label for='choice_110_56_1' id='label_110_56_1' class='gform-field-label gform-field-label--type-inline'>I disagree - there ARE personal mental health issues, trauma or major life events that are likely to affect my experience of this course.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_56_2'>\n\t\t\t\t<input name='input_56' type='radio' value='I am not sure.'  id='choice_110_56_2'    \/>\n\t\t\t\t<label for='choice_110_56_2' id='label_110_56_2' class='gform-field-label gform-field-label--type-inline'>I am not sure.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_57\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_57'>Please explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_57' id='input_110_57' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you had any previous experience of mindfulness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_60'>\n\t\t\t<li class='gchoice gchoice_110_60_0'>\n\t\t\t\t<input name='input_60' type='radio' value='Yes'  id='choice_110_60_0'    \/>\n\t\t\t\t<label for='choice_110_60_0' id='label_110_60_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_60_1'>\n\t\t\t\t<input name='input_60' type='radio' value='No'  id='choice_110_60_1'    \/>\n\t\t\t\t<label for='choice_110_60_1' id='label_110_60_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_61\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_61'>Please tell us about your experience of mindfulness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_61' id='input_110_61' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_62\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_62'>If there anything else you think it would be helpful for us to be aware of, please feel free to use the box below to outline this.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_62' id='input_110_62' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_110_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Where did you hear about this course?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_42'><li class='gchoice gchoice_110_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Your school'  id='choice_110_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_1' id='label_110_42_1' class='gform-field-label gform-field-label--type-inline'>Your school<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Another organisation'  id='choice_110_42_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_2' id='label_110_42_2' class='gform-field-label gform-field-label--type-inline'>Another organisation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='A friend'  id='choice_110_42_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_3' id='label_110_42_3' class='gform-field-label gform-field-label--type-inline'>A friend<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='A MiSP Leaflet'  id='choice_110_42_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_4' id='label_110_42_4' class='gform-field-label gform-field-label--type-inline'>A MiSP Leaflet<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='A MiSP email'  id='choice_110_42_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_5' id='label_110_42_5' class='gform-field-label gform-field-label--type-inline'>A MiSP email<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.6' type='checkbox'  value='A Facebook advert'  id='choice_110_42_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_6' id='label_110_42_6' class='gform-field-label gform-field-label--type-inline'>A Facebook advert<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.7' type='checkbox'  value='A MiSP event or stand'  id='choice_110_42_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_7' id='label_110_42_7' class='gform-field-label gform-field-label--type-inline'>A MiSP event or stand<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.8' type='checkbox'  value='Internet search'  id='choice_110_42_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_8' id='label_110_42_8' class='gform-field-label gform-field-label--type-inline'>Internet search<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.9' type='checkbox'  value='MiSP on Facebook'  id='choice_110_42_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_9' id='label_110_42_9' class='gform-field-label gform-field-label--type-inline'>MiSP on Facebook<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.11' type='checkbox'  value='MiSP on X (formerly Twitter)'  id='choice_110_42_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_11' id='label_110_42_11' class='gform-field-label gform-field-label--type-inline'>MiSP on X (formerly Twitter)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.12' type='checkbox'  value='MiSP on Linked In'  id='choice_110_42_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_12' id='label_110_42_12' class='gform-field-label gform-field-label--type-inline'>MiSP on Linked In<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_110_42_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.13' type='checkbox'  value='Other'  id='choice_110_42_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_42_13' id='label_110_42_13' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_43'>Please enter the search term used<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_110_43' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_110_44'>Please state<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_110_44' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_110_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >We\u2019d love to stay in touch.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_38'>\n\t\t\t<li class='gchoice gchoice_110_38_0'>\n\t\t\t\t<input name='input_38' type='radio' value='I\u2019d like to be kept up to date once I have completed Teach .breathe so I can find out about what\u2019s on offer in the HUB, MiSP news and events, practice groups and training with MiSP in the future.' checked='checked' id='choice_110_38_0'    \/>\n\t\t\t\t<label for='choice_110_38_0' id='label_110_38_0' class='gform-field-label gform-field-label--type-inline'>I\u2019d like to be kept up to date once I have completed Teach .breathe so I can find out about what\u2019s on offer in the HUB, MiSP news and events, practice groups and training with MiSP in the future.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_38_1'>\n\t\t\t\t<input name='input_38' type='radio' value='I\u2019d prefer not to be contacted'  id='choice_110_38_1'    \/>\n\t\t\t\t<label for='choice_110_38_1' id='label_110_38_1' class='gform-field-label gform-field-label--type-inline'>I\u2019d prefer not to be contacted<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_103\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<\/label><div class='ginput_container ginput_container_consent'><input name='input_103.1' id='input_110_103_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_110_103_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_103.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_103.3' value='15' class='gform_hidden' \/><\/div><\/li><li id=\"field_110_122\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Online courses:<\/h2><div class='gsection_description' id='gfield_description_110_122'>We would like you to get the very most out of this online course.  Please be prepared as follows.<\/div><\/li><li id=\"field_110_114\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand it is my responsibility to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_114'><li class='gchoice gchoice_110_114_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.1' type='checkbox'  value='Use the Zoom test call function to test my camera, microphone and sound prior to the course.'  id='choice_110_114_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_114_1' id='label_110_114_1' class='gform-field-label gform-field-label--type-inline'>Use the Zoom test call function to test my camera, microphone and sound prior to the course.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_116\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand it is my responsibility to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_116'><li class='gchoice gchoice_110_116_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_116.1' type='checkbox'  value='Use a computer which is resting on a hard surface (rather than using a handheld device for the training).'  id='choice_110_116_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_116_1' id='label_110_116_1' class='gform-field-label gform-field-label--type-inline'>Use a computer which is resting on a hard surface (rather than using a handheld device for the training).<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_117\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand it is my responsibility to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_117'><li class='gchoice gchoice_110_117_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_117.1' type='checkbox'  value='Keep my camera on for the duration of the training.'  id='choice_110_117_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_117_1' id='label_110_117_1' class='gform-field-label gform-field-label--type-inline'>Keep my camera on for the duration of the training.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_115\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand it is my responsibility to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_115'><li class='gchoice gchoice_110_115_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_115.1' type='checkbox'  value='Ensure I can attend the training from a room with a closed door where I will not be interrupted.   If I have no alternative but to attend the course from my workplace, I will ensure that my colleagues understand that I will not be available for work-related tasks or responsibilities such as supervising students or attending meetings.'  id='choice_110_115_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_115_1' id='label_110_115_1' class='gform-field-label gform-field-label--type-inline'>Ensure I can attend the training from a room with a closed door where I will not be interrupted.   If I have no alternative but to attend the course from my workplace, I will ensure that my colleagues understand that I will not be available for work-related tasks or responsibilities such as supervising students or attending meetings.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_118\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand it is my responsibility to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_110_118'><li class='gchoice gchoice_110_118_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_118.1' type='checkbox'  value='Bring a commitment to learning and a willingness to participate in this training.'  id='choice_110_118_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_110_118_1' id='label_110_118_1' class='gform-field-label gform-field-label--type-inline'>Bring a commitment to learning and a willingness to participate in this training.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_110_138\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_110_138 gfield_product_110_138 field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_110_138_1'>Course Cost<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_138.1' value='Course Cost' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_110_138' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_138.2' id='ginput_base_price_110_138' value='&#163; 225.00' aria-label='Course Cost Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_138.3' value='1' class='ginput_quantity_110_138 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_110_131\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full margin-vertical-8 gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_110_131'>\n\t\t\t<li class='gchoice gchoice_110_131_0'>\n\t\t\t\t<input name='input_131' type='radio' value='Pay now by bank card or PayPal (If you choose to pay by PayPal we accept PayPal in 3. This should be an option in your Paypal account at point of payment.)'  id='choice_110_131_0'    \/>\n\t\t\t\t<label for='choice_110_131_0' id='label_110_131_0' class='gform-field-label gform-field-label--type-inline'>Pay now by bank card or PayPal (If you choose to pay by PayPal we accept PayPal in 3. This should be an option in your Paypal account at point of payment.)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_131_1'>\n\t\t\t\t<input name='input_131' type='radio' value='Pay now by BACs (see bank details below)'  id='choice_110_131_1'    \/>\n\t\t\t\t<label for='choice_110_131_1' id='label_110_131_1' class='gform-field-label gform-field-label--type-inline'>Pay now by BACs (see bank details below)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_131_2'>\n\t\t\t\t<input name='input_131' type='radio' value='Request a MISP Supported Place (I have entered details in the supported places section)'  id='choice_110_131_2'    \/>\n\t\t\t\t<label for='choice_110_131_2' id='label_110_131_2' class='gform-field-label gform-field-label--type-inline'>Request a MISP Supported Place (I have entered details in the supported places section)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_110_131_3'>\n\t\t\t\t<input name='input_131' type='radio' value='My place is fully funded (I have entered the funding code in the support places section)'  id='choice_110_131_3'    \/>\n\t\t\t\t<label for='choice_110_131_3' id='label_110_131_3' class='gform-field-label gform-field-label--type-inline'>My place is fully funded (I have entered the funding code in the support places section)<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_110_131'>For course booking and payment terms please refer to the <a href=\"https:\/\/mindfulnessinschools.org\/terms-conditions\/booking-a-course\/\" target=\"_blank\">Terms and Conditions<\/a><\/div><\/li><li id=\"field_110_139\" class=\"gfield gfield--type-paypal gfield--input-type-paypal gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gform_ppcp_custom_card_fields\"  data-field-class=\"gform_ppcp_custom_card_fields\" ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_110_139_1' ><label class='gfield_label gform-field-label'>Payment Method<\/label><\/label><div class='ginput_container ginput_container_select gform_ppcp_payment_method' ><select name='input_139.6' id='input_139_6' class='medium gfield_select' ><option value='PayPal Checkout' selected='selected'>PayPal Checkout<\/option><option value='Credit Card' >Credit Card<\/option><\/select><\/div><div class='ginput_complex ginput_container ginput_container_custom_card_fields gform-grid-row' id='input_110_139' ><span class='ginput_full gform-grid-col' id='input_110_139_1_container' >\n                                    <div class='gform_card_icon_container gform_card_icon_style1'><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_110_139_supported_creditcards'>Supported Credit Cards: MasterCard, Visa<\/span><\/div>\n                                    <label for='input_110_139_1' id='input_110_139_1_label'  class='gform-field-label gform-field-label--type-sub'>Card Number<\/label>\n                                    <span id='input_110_139_1' class='ginput_card_field ginput_card_number gform-theme-field-control'><\/span>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_110_139_2_container'>\n                                            <span class='ginput_cardinfo_left gform-grid-col' id='input_110_139_2_cardinfo_left'>\n                                                <label for='input_110_139_2'  class='gform-field-label gform-field-label--type-sub'>Expiration Date<\/label>\n                                                <span id='input_110_139_2' class='ginput_card_field ginput_card_expiration gform-theme-field-control'><\/span>\n                                            <\/span><span class='ginput_cardinfo_right gform-grid-col' id='input_110_139_2_cardinfo_right'>\n                                                <label for='input_110_139_3'  class='gform-field-label gform-field-label--type-sub'>Security Code<\/label>\n                                                <span id='input_110_139_3' class='ginput_card_field ginput_card_security_code gform-theme-field-control'><\/span>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                             <\/span>\n                                        <\/span><span class='ginput_full gform-grid-col' id='input_110_139_5_container'>\n                                            <label for='input_110_139_5' id='input_110_139_5_label'  class='gform-field-label gform-field-label--type-sub'>Cardholder Name<\/label>\n                                            <input type='text' name='input_139.5' id='input_110_139_5' value=''  \/>\n                                        <\/span> 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