Women's Spring Retreat Registration
Women's Vipassana Retreat with Jill Rayna & Shelley Hainer
Friday, April 27 - Sunday, May 6, 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 *
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Gender identification *
Arrival Date *
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Departure Date *
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Ride Needed from Palm Springs Airport? (Arrival)
Please select your flight arrival time, with AM or PM
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Time
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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
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