Aotearoa National Retreat 25/26th May- 1st June 2019
Please provide accurate information and save a copy of this form for your own records. If you need to alter any information or have any questions please email Val -
OR Darryl -
All information you provide will remain confidential.
2. YOUR EMAIL ADDRESS
3. YOUR TELEPHONE NUMBERS
All accommodation prices are per person (pp) Double rooms are very limited.
Quad bunkroom/ensuite: Bottom bunk $590.00 pp
Quad bunkroom/ensuite: Top bunk $500.00 pp
Double/ensuite: $850.00 pp
12 bed bunk room (mixed gender): $450.00 pp
Staying offsite, retreat & food: $400.00pp
Other - less days by arrangement
Towels & Linen (includes sheets,pillowcase,towel,duvet,pillow)
Pillow only: $5
6. AIRPORT TRANSPORT
$25.00 per one way trip. Please note the shuttle departure times. You will need to book your flights to connect.
Airport to Wainui. Teacher only day Sat 25/5, shuttle departs airport 12pm.
Airport to Wainui. Participants Sun 26/5, shuttle departs airport at 2pm,.
Wainui to airport Sat 1/6 departs 1pm, arives at the airport aproximately 3pm. .
6a. Bus total
Total bus fares ($25 per one way trip)
7. RETREAT DURATION
How many days are you attending?
Seven days (all teachers who have completed a Teacher Training module are welcome)
8. TOTAL FEE PAYABLE
Include all add ons in total i.e. linen, bus ( Account no: 03-1355-0650146-00 )
9. DEPOSIT PAID
MORE ABOUT YOU
11. FOOD REQUIREMENTS (if any)
All meals are vegetarian. Please indicate any special dietary requirements e.g. vegan,dairy/gluten free. There is no access to a kitchen for preparing your own food.
Are you on any medication we should be aware of?
Do you have any allergies?
List any important medical conditions that may effect your progress or participation during the retreat.
I would like to discuss my condition with Dr Jackie Blunt
Have you been admitted to hospital in the last year?
Do you have a history of any psychiatric conditions?
13. YOUR YUAN GONG PRACTICE
Please specify which of the following forms you do not know or would like tuition for.
Tian Yuan (1st method)
Di Yuan (2nd method)
Ren Yuan (3rd method)
I am a competent practitioner
14. LENGTH OF PRACTICE
How long have you been practicing Yuan Gong?
15. BUDDY SYSTEM
Would you like to be linked to a buddy? It can be helpful to have someone ther you know you can touch base with.
Do you have a preferred person you would like to buddy with?
16. TEACHERS PARTICIPATION
Would you like to be involved giving a presentation, teaching or demonstration? Please indicate your level of Teacher Training and if you are currently teaching.
17. NEXT OF KIN
Required in case of emergency. Name, Contact phone, email, relationship
18. ANY ADDITIONAL COMMENTS OR INFORMATION YOU WOULD LIKE TO PROVIDE
CAR / RIDE SHARING (if you have spare seats to/from Wainui)
I can offer a ride
I would like a ride
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service