Heart Chan Sacred Light Mountain Retreat Center
987 Shenendoa Drive, Ellijay, GA 30540
herrc@heartchan.org
www.heartchan.org
Application to Sacred Light Mountain Retreat
This application must be filled out completely for anyone planning to have a private retreat at the Sacred Light Mountain Heart Chan Eastern Regional Retreat Center (hereinafter referred to as SLM). Please do not make any travel plans until you have received a written approval for your request from SLM management.

All information provided is for Heart Chan/SLM management to make decision and for emergency purposes only and will be kept confidential.
Applying for the first time? *
First Name *
Last Name *
Phone Number *
E-mail *
Gender *
What are you applying for? *
List the purposes/objectives of your visit
Proposed Arrival Date *
MM
/
DD
/
YYYY
Proposed Arrival Time *
Time
:
Proposed Departure Date *
MM
/
DD
/
YYYY
Proposed Departure Time *
Time
:
Next
Never submit passwords through Google Forms.
This form was created inside of Heart Chan. Report Abuse