Registration Form for Flexible Date Meditation Retreat
Sign in to Google to save your progress. Learn more
Email *
Information
Information
Schedule for Flexible Date Retreat
Accommodation
Important Notice
Important Notice
More information
Please contact +66-82-141-1400 WhatsApps +66821411400, +66957872868
Date you plan to join the flexible retreat *
MM
/
DD
/
YYYY
Time of arrival *
Time
:
Date you plan to leave *
MM
/
DD
/
YYYY
Time of leaving *
Time
:
Name and Last Name *
Nationality *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number (The format consist of Country Code - Area or Mobile Code - Phone Number. If your phone number is +1 505-644-9442, please put 15056449442 as formatted.) *
WhatsApp or Messenger contact ID
Career *
If you plan to stay one day or overnight, please inform us your food restriction
Clear selection
If you plan to stay overnight to practice meditation with us, please choose rooms
Clear selection
Have you ever meditate before?
 *
Meditation experiences
If you check (YES) Please describe it here.
What kind of session do you prefer?
How did you find out about the Flexible Date Meditation Retreat?
Clear selection
Please pay before joining the retreat. You can pay in USD or Thai Baht. Air Con Room with Shared Bathroom is 55USD (1650 Baht)/Night/ Person. Fan Room is 40 USD (1250 Baht/Night/Person. If you plan to stay more than one night or come with friends, please put amount in quantity. Once finish payment, please come back and click "SUBMiT" to finish form.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms