PLEASE NOTE: Payment is REQUIRED
to secure your place and complete registration.
Option 1: Payment in full
Option 2: Payment in Installments:
If you choose to pay the course tuition in installments,
a $995 DEPOSIT secures your space in the training.
The remaining balance of $3300 is due by December 15th, 2019.
We only accept payment online (via PayPal) .
After you submit this form, you will be re-directed to a separate page
in order to complete your registration with a payment.
Waiver of Liability
I accept full responsibility for my health and voluntarily complete this Acknowledgment and Waiver of Liability. I understand and agree that the services and tools offered by Robert Cusick, Neelama Eyres, the Center for Compassion and Altruism Research and Education (CCARE), and Stanford University are not intended to replace or be substituted for medical or psychiatric care. It is recognized that the trainings may at times make participants feel vulnerable. The APPLIED COMPASSION TRAINING™ (ACT)
is not a therapeutic intervention for psycho-pathological disorders as defined in the DSM, and is not meant to be used as such. By completing this release and consent I assume all risk for any physical or mental consequences of participating in the course.
By signing this release I also specifically and expressly agree to hold harmless, indemnify and release Robert Cusick and Neelama Eyres, the Center for Compassion and Altruism Research and Education (CCARE) and Stanford University and each of their respective employees, partners, agents and associates from any and all liability for the results of the educational guidance that will be or has been provided. Moreover, I acknowledge that the particulars shared in the 10-month Applied Compassion Training by other participants are to be maintained as confidential. I will not blog or otherwise report on content shared in this class in any form of media.
I also acknowledge that taking this course does not entitle participants to represent themselves as affiliates to or with Robert Cusick & Neelama Eyres.
Waiver of Dismissal
If at any point during the course of this 10-month training we determine that a student’s participation needs to be terminated, we reserve the right to dismiss that student from
the program. If a student is dismissed, they will be refunded a pro-rated amount of their tuition within 30 days.
Full refunds may only be issued if your cancellation request is received no later than November 15th, 2019 prior to start of the workshop on January 10th 2020. A partial refund (minus a $250 processing fee) may be issued if the cancellation request is received 6 weeks before the first class session. No refunds will be made for cancellations less than
6 weeks before the first class session. All refund requests must be sent by email to: email@example.com
By clicking the box below, I confirm that I have read the description for this class and understand the requirements. I would like to register for this class and I confirm that I have read, understand, and agree to the waiver of liability and dismissal, and the cancellation/refund policy.