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 - valswatridge@gmail.com OR Darryl - stonepapersissors@gmail.com
All information you provide will remain confidential.
Email address *
Full Name *
Your answer
2. YOUR EMAIL ADDRESS *
Your answer
YOUR AREA *
Your answer
3. YOUR TELEPHONE NUMBERS *
Mobile: Landline:
Your answer
4. ACCOMMODATION *
All accommodation prices are per person (pp) Double rooms are very limited.
5. LINEN
Towels & Linen (includes sheets,pillowcase,towel,duvet,pillow)
6. AIRPORT TRANSPORT
$25.00 per one way trip. Please note the shuttle departure times. You will need to book your flights to connect.
6a. Bus total
Total bus fares ($25 per one way trip)
Your answer
7. RETREAT DURATION *
How many days are you attending?
8. TOTAL FEE PAYABLE *
Include all add ons in total i.e. linen, bus ( Account no: 03-1355-0650146-00 )
Your answer
9. DEPOSIT PAID *
Minimum $100.00
Your answer
10. *
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.
Your answer
12. MEDICAL
13. YOUR YUAN GONG PRACTICE *
Please specify which of the following forms you do not know or would like tuition for.
Required
14. LENGTH OF PRACTICE *
How long have you been practicing Yuan Gong?
Your answer
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?
Your answer
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.
Your answer
17. NEXT OF KIN *
Required in case of emergency. Name, Contact phone, email, relationship
Your answer
18. ANY ADDITIONAL COMMENTS OR INFORMATION YOU WOULD LIKE TO PROVIDE
Your answer
CAR / RIDE SHARING (if you have spare seats to/from Wainui)
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