Your Name:
Email:
Home Phone:
Mobile/other Phone:
Gender:
Female
Male
Additional Participant Name:
... and Email:
Mailing Address:
City:
State (U.S.):
... or Province or Region:
Zip/Postal Code:
Country:
Emergency Contact Name:
Relationship:
Phone:
Accommodations and Program Fees
(If registering for the entire retreat
before Nov 15th you may deduct $75)
Single Room $1195
Double Occupancy $950
Non residential / commuter: $685
Part-time Single Room, per day: $150
Part-time Double Occupancy, per day: $125
Part-time Nonresidential, per day: $90
Part time participants:
when will you be arriving and departing (dates, and before/after which meal?)
Preferred roommate (if double room):
Any food allergies?
Meals:
Non-Vegetarian
Vegetarian
Vegan
No Wheat
No Dairy
Concerns, physical or emotional,
about participating that you would like to let us know about?
(Registrar will contact you).
Total amount due: $
Amount due now: $
- Your deposit of $150 (not refundable) will hold your space.
- Registration will be confirmed when paid in full.
- Fees provide only minimal support for the teachers. There will be an opportunity
to give 'dana' (further financial generosity) at the retreat.
Will pay by:
Credit Card or PayPal
Mailing check
