"Connecting the Dots" Retreat Registration
Awakening to Our Intimacy with All that Lives with Sandy Boucher & Martha Boesing
Wednesday, February 14 - Sunday, February 18, 2018
Email address *
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Phone numbers (list all, indicating cellphone) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender identification *
Arrival Date *
MM
/
DD
/
YYYY
Departure Date *
MM
/
DD
/
YYYY
Ride Needed from Palm Springs Airport? (Arrival)
Please select your flight arrival time, with AM or PM
MM
/
DD
Time
:
What is your Arrival Airline & Flight Number?
Your answer
Ride Needed to Palm Springs Airport? (Departure)
Please select your flight arrival time, with AM or PM
MM
/
DD
Time
:
What is your Departure Airline & Flight Number?
Your answer
Special Dietary Needs
Please note that we will be offering gluten-free options for all meals.
Do you have any special needs for housing, or for your health?
Your answer
Have you attended a retreat here before? *
Are you new to Vipassana meditation? *
Where did you hear about the retreat? *
Required
Scholarship/Work Exchange Requested
$100 deposit
NOTE: Your registration is not confirmed without a deposit
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms