Use the form below and register to join us for retreat and renewal in January!
First Name: Last Name: Email:
Home Phone: Mobile/other Phone:
Age: Gender: Female Male
Mailing Address: City:
State (U.S.): (N/A) AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming ... or Province etc:
Zip/Postal Code: Country: <Select One> Afghanistan Albania Algeria Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil BIOT Brunei Dar Bulgaria Burkina Faso Burundi Caicos Islands Cambodia Cameroon Canada Cape Verde Cayman Islands Cent Afric Rep Chad Chile China Christmas Is Cocos Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Rep East Timor Ecuador Egypt El Salvador Eq. Guinea Eritrea Estonia Ethiopia Falkland Is. Faroe Islands Fiji Finland France France, Metro Fr Guiana Fr Polynesia Fr So. Terr. Futuna Is Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Herzegovina Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Rep of) Iraq Ireland Israel Italy Jamaica Jan Mayen Islands Japan Jordan Kazakhstan Kenya Kiribati Korea Korea (Democratic) Kuwait Kyrgystan Lao Latvia Lebanon Lesotho Liberia Libya Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mc Donald Is Mexico Micronesia Miquelon Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Neth. Antilles Neutral Zone Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island No. Mariana Is. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Samoa Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Tobago Tunisia Turkey Turkmenistan Uganda Ukraine UAE United Kingdom United States Uruguay US Min Outlying Is Uzbekistan Venezuela Viet Nam Virgin Islands (Brit) Virgin Islands (US) Yemen Yugoslavia Zaire Zimbabwe
Emergency Contact Name: Relationship: Phone:
Accommodations and Program Fees Single $1090 paid online, $1050 by check Double $880 paid online, $850 by check Non residential: $625 paid online, $600 by check Deposit of $100 holds your space. Balance due December 15th. Part-time participants, ask the registrar, Alia, for your specific fees. 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): If interested in coming part-time, please note that you are requested to join with us from the beginning. Please use this space to let us know your departure date and your choice of accommodation: The registrar will be in touch with you. Meals: Non-Vegetarian Vegetarian Vegan No Wheat No Dairy Concerns, physical or emotional, about participating. (Registrar will contact you). Amount due: $ Will pay by: Credit Card or PayPal Mailing check Questions or Comments (if any):
Single $1090 paid online, $1050 by check Double $880 paid online, $850 by check Non residential: $625 paid online, $600 by check Deposit of $100 holds your space. Balance due December 15th. Part-time participants, ask the registrar, Alia, for your specific fees. 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): If interested in coming part-time, please note that you are requested to join with us from the beginning. Please use this space to let us know your departure date and your choice of accommodation: The registrar will be in touch with you. Meals: Non-Vegetarian Vegetarian Vegan No Wheat No Dairy Concerns, physical or emotional, about participating. (Registrar will contact you). Amount due: $ Will pay by: Credit Card or PayPal Mailing check Questions or Comments (if any):
Questions or Comments (if any):