Wake Up New Year's retreat 2019-2020
Dear Wake up friend.

With this form you can sign up for the Wake Up New Year's retreat 2019-2020 at the Cordium in Nijmegen. After signing up and if there is a spot available, you will get an email with payment instructions on the 5th of December. If there is no spot available, we will put you on the waiting list and contact you when there's is a free spot.

We are really excited that you are signing up and are looking forward to see you.

Warm greetings.

Niels, Jasmijn, Hester and Ludo
Name *
Your answer
Email adress *
Your answer
Gender *
Age *
Your answer
Phone number *
Your answer
City of residence *
Your answer
First language
Do you prefer to be in a Dutch speaking family / an English speaking one, or comfortable with both? *
Will you sleep at Cordium during the retreat? *
There is a limited amount of mattresses available. Are you okay with sleeping on your own mat/air bed if there is no mattress available anymore? *
To what extent do you have experience with going to a Wake Up sangha? *
If you go to a Wake Up sangha, in which city is it?
Your answer
Are you aware that you need to bring your own lunch package and a (vegan/vegetarian) dish to share with the potluck dinner on the first day? Only breakfast in the morning of January 1st is provided. *
Do you have allergies we can take in account?
Your answer
The retreat is organized by a small team, but is carried by the whole group. Is it OK if we contact you to help facilitate one part of the program like a meditation, workshop or guiding a family? We will get in touch with you (dependant on your answer).
Name of a relative or friend we can contact in case of an emergency (and how this person is related to you, e.g. 'father', 'girlfriend', 'friend', 'aunt'...):
Your answer
Phone number of this person:
Your answer
Do you have any questions, do you want to explain something or do you have information you like to share with us or want us to know of (maybe medical or mental conditions, medicines).
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Wake-Up Movement - Plum Village Community of Engaged Buddhism. Report Abuse