Personal Retreats Registration Form
Full Name *
Your answer
Email Address *
Your answer
Requested Arrival Date *
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Requested Departure Date *
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We do our best to accommodate your preferences. You will be notified if your choice is not available. I would like my accommodations to be in: *
Home Phone: *
Your answer
Cell Phone: *
Your answer
What city are you coming from? *
Your answer
What province/state are you coming from? *
Your answer
What country are you coming from? *
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Phone Number: *
Your answer
We usually send a Paypal invoice which you can pay with any credit card, bank account, Paypal account or e-check. Would you like us to send you a Paypal invoice to secure your place at the Center? We also use Interac Money Transfer if you prefer that method. *
Do you have daily meditation practice? (please describe): *
Your answer
Please describe in detail what you hope to gain from your time at the Samadhi Center. *
Your answer
Have you done meditation retreats before? If so please describe in detail. *
Your answer
Do you have any health issues that may affect any aspect of your stay at the Center? *
Your answer
Although meditation is helpful for most people, it is not a substitute for medical or psychiatric treatment and we do not recommend it for people with serious psychiatric disorders. If you are unsure whether a meditation retreat is right for you please contact us at contact@samadhi.ca. If you have a history of mental illness or are on any mind-affecting drugs please leave any pertinent information in the space below. *
Your answer
The bunk beds can safely support persons of up to 200lbs. Is your weight over 200lbs? We will try to accommodate accordingly. *
Do you have any serious allergies, or environmental health concerns? *
Your answer
Do you snore? (We try to adjust the dorms accordingly) *
Each day participants contribute "seva" or "selfless service" to the operations of the center. Please select the job(s) for which you are best suited. *
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