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NeuroAwakening Thanksgiving Retreat Registration 2017
Neurofeedback Enhanced Meditation, November 24-26, 2017. Please complete one form per person.
Email completed form to
Email address *
Echo Rock Neurotherapy Retreat at St Francis Center
First Name *
Your answer
Last Name: *
Your answer
Street Address *
Your answer
City *
Your answer
State/Province *
Your answer
Postal Code *
Your answer
Your answer
Cell phone *
Your answer
Have you experienced neurofeedback at EchoRock Neurotherapy? *
check the statement that best applies
Are you currently being treated by a physician? *
Are you mobility-impaired and rely on support?
Check if applicable
How often do you practice a specific style of meditation? *
Choose the answer that best describes your experience
How long have you been practicing meditation if any ? *
Choose the answer that best describes it
Briefly describe your meditation experience. *
Your answer
Do you have special dietary or medical needs?
A retreat manager will follow up to review your special needs.
Your answer
Room Selections *
Single men and women are quartered separately. Cabins available for partners in relationship
Menu Selection *
How will you get there? *
Contact Jordan at and enter your comments below.
Your answer
Will you pay with Check, Credit Card or PayPal?
Make your payment using the on the Website payment button
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