Registration for Sit & Schmooze Jewish Mindfulness Retreat (March 20-22, 2015)
Hi! We're excited that you want to join us for our retreat March 20-22, 2015 at Vajrapani in Boulder Creek, CA.

Please answer the questions below to begin your reservation.

To complete your reservation please send $182 (for a quad) or $165 (for dorm) via paypal to z.bellinlpcc@gmail.com. If you would like to send a check, please mail to:

Zvi Bellin
533 63rd St
Oakland, CA 94609
Name (First and Last) *
Email *
Phone Number *
Age *
Gender for Rooming Preference in Dorm or Quad *
A little about yourself...
How do you spend your days? (job, school, etc.):
What kind of room would you like? *
Space and configurations are limited (12 dorm spots and 8 quad spots), so we will do our best to accommodate your choice. We work hard to keep our costs affordable. Please note this includes room and board, but not payment for the teachers, who give freely and will accept donations at the end of the retreat. If you are in need of other rooming options (single/camping), please email z.bellinlpcc@gmail.com.
Required
Retreat experience (if any)
Please list any past retreat experience
Medical/Mental Health
Please share any medical or mental health conditions that might be important for the facilitators to know that might effect your physical abilities, emotional state, or concentration. The main purpose of this question is to identify any accessibility needs and other concerns that might interfere with personal exploration work.
Current Practice
If you have a regular meditation practice, please describe
Dietary Needs
Please list any special dietary needs (noting that all food will be vegetarian)
Where will you be coming from?
Transportation
If you will be driving, do you have space to offer a ride to other participants? If so, how many spaces?
Transportation 2
Do you need a ride?
Clear selection
Encouraging Thought
What are you appreciating today?
Submit
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