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 1st
you may deduct $75)
Single Room $1170
Double Room $925
Non residential / commuter: $660
Part-time Double Room, per day: $125
Part-time Nonresidential, per day: $89
Part time participants:
when will you be arriving and departing (dates, and before/after which meal?)
- Deposit of $150 holds your space. Balance due December 15th.
- Fees provide only minimal support for the teachers. There will be an opportunity
to give 'dana' (further financial generosity) at the retreat.
Preferred roommate (if double room):
NOTE: Please let us know if you are allergic/intolerant to any specific foods or ingredients
using the Comments box below.
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).
Amount due: $
Will pay by:
Credit Card or PayPal
Mailing check
Questions or Comments (if any):
