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Soul to Soul - Registration Form
A meditation retreat in Perth

14—17 April 2016
Kerem Adventure Camp (50 mins off Perth)
AU$295/pax

**NOTE**: THIS IS JUST REGISTRATION AND NOT CONFIRMATION OF YOUR ATTENDANCE. CONFIRMED PARTICIPANTS WILL BE NOTIFIED VIA EMAIL.

Email address *
Your Full Name *
Your answer
You date of birth (dd/mmm/yyy) *
Your answer
What's your occupation? *
Your answer
Where are you from? Enter city and country. *
Your answer
What's your mobile no.? Please include country and city code. *
Your answer
Your whatsapp no., if it's different from your mobile no.
Your answer
Are you a Samarpan Meditator? *
If yes, which centre are you from? *
Your answer
Please provide name and contact details of centre/area head. *
Your answer
Do you participate in any Volunteer activities? *
If yes, please provide details of volunteer activities undertaken
Your answer
Are you interested to volunteer for tasks during the retreat? *
If yes, which area are you interested in?
Do you have any food allergies or special dietary requirements? *
If Yes, please specify your food allergies or special dietary requirements.
Your answer
The cost for this retreat is AU $295/pax *
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