Level 5 Yuan Gong, Yuan Ming Medicine and Ren Xue Professional Training Registration Form (4-17 November, 2017)
Welcome to the Yuan Tze Centre retreat registration page.
* Please note that full attendance (from Day 1 group healing to Day 14 graduation) of the 2-week course is required for sitting the exams.
** To avoid unnecessary administrative work at a later stage, it is essential that you provide accurate information. If you need to adjust your response after submitting the form, please notify Melissa via email.
*** All information you provide will remain confidential.
****It is highly recommend that you read 'WELLBEING BEGINS WITH YOU' by Yuan Tze as preparation for the Level 5 training.
Thank you for your cooperation.
1. First Name
(The name to show on your certificate.)
Your answer
2. Last Name
Your answer
3. Your cell phone number in New Zealand
Your answer
4. Your email address
Your answer
5. Accommodation
*Single and twin rooms are booked out. *Keswick accommodation is NOT available before the retreat. To stay over after the retreat, please arrange the reservation and payment with them directly.
6. Do you need to hire towels and linen? (Pre-booking is essential as the camp has to outsource linen.)
available at an extra $17, including 2 single sheets, 1 duvet, 1 pillow, 1 pillowcase and 1 towel. Towels will be changed every 3 days and sheets once during the stay.
7. Have you paid the NZD200 deposit?
Please note your booking becomes valid only after we receive your deposit.
8. Dietary requirements
9. Emergency contact details
Your answer
Phones of the emergency contact person (landline AND cell if known)
Your answer
Email of the emergency contact person (type NONE if not available)
Your answer
10. Medical information
Do you have any medical condition or allergy which might require urgent attention or influence your progress or paticipation during the retreat? You must disclose if you have any mental or neurological condition that might cause mental instability or disruption to normal communication with others.
Your answer
11. Any comments or additional information you would like to give us:
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms