form – smartMigraine Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Mindfulness for Migraine Fall 2026 Reserve My Spot Name *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmail *Preferred Phone *I agree to a phone conversation to discuss the course *yesSomeone from Mindfulness Everyday will call you to discuss the program to confirm whether this course is good for you.I would prefer the following course date: *Wednesdays 6:30-8pm ET, 7-28 October 2026Saturdays 12-1:30pm ET, 7-28 November, 2026What gender do you identify with?MaleFemaleOtherMultiple Choice0-2526-3536-4546-55over 55Where did you learn about this Mindfulness for Migraine course?Mindfulness Everyday WebsiteGoogle or other Search EngineMindfulnesseveryday NewsletterSocial MediaColleague or FriendMigraine CanadaOtherDo you have any physical requirements that we should be aware of? * regardless Where phone Any other information that you’d like us to know that would impact your participation in the course?Mindfulness Everyday Liability Waiver: We are committed to the safety and well-being of our participants at all times. We insist that all participants follow safety instructions designed to protect them. Participants must recognize, however, that the risk of injury still exists. By checking the box below, you hereby agree to assume the full risk of any personal injury, loss or damage to property, regardless of severity, arising from their participation in the program, and agree to waive all related claims against Mindfulness Everyday. *I agreeInsurance: MBSR / SMART / MSC / M4Migraine is not therapy or medical treatment. However, some insurance plans do cover health education and wellness classes. If your plan covers a mindfulness program, we will provide the information you need to request reimbursement directly from your insurer. Course FeePrice: $250.00In the spirit of generosity, spaces are available to those who genuinely cannot afford the full cost of the retreat. Alternative payment options may be considered. Please contact Nantanya.Mandel@mindfulnesseveryday.org to review optionsPayPal Commerce payments are disabled because your connection is not set up correctly. Please ask your site administrator to check the connection settings.Submit