Nourishing and Letting Go: Retreat Application
Email address *
Name *
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I identify as... *
Preferred Personal pronouns *
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Address including city, state/province, and zip/postal code *
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Phone number *
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Emergency contact person: include name, relationship to you, contact information *
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Room preference *
How would you like to pay?
If you are signing up with someone/willing to share a room, please include the name of your co-registrant
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Significant Dietary Restrictions (please note that we will do our best to accommodate. If restrictions are severe, please contact us)
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Are you allergic to feathers? (There will be a few rooms with feather-free pillows/blankets) *
Props: We will provide chairs and will have some meditation cushions (and a small number of benches) available. Please let us know if you prefer to use a cushion, bench, or chair. Please choose one. *
Please share any physical or emotional needs (including mobility challenges) that it would be helpful for us to know/you want us to know about.
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Previous mindfulness and retreat experience (for example: teachers, years practicing, # of retreats) *
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Please describe your current mindfulness practice or experience with mindfulness/meditation *
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Current role/occupation *
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What would make this retreat successful for you? *
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How did you hear about us?
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Is there anything else you'd like to add or share. Questions? Issues? Concerns? Jokes? Just nice things you want to say? :)
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