Aotearoa National Retreat, 19th May - 26th May2018 - Registration Form
Please provide accurate information and save a copy of this form for your own records. If you need to alter any information or have any questions please email Val - valswatridge@gmail.com OR Darryl - stonepapersissors@gmail.com
All information you provide will remain confidential.
Thank you for your cooperation.
1. NAME *
Your answer
2. YOUR EMAIL ADDRESS *
Your answer
YOUR AREA *
Your answer
3. YOUR TELEPHONE NUMBERS *
Mobile: Landline:
Your answer
4. ACCOMMODATION *
All accommodation prices are per person (pp) Double rooms are limited.
5. LINEN
Towels & Linen ((includes sheets,pillowcase,towel,duvet,pillow)
6. AIRPORT TRANSPORT
Please book flights to connect with the bus departure times. $25.00 per trip.
6a. Bus total
Total bus fares ($25 per trip)
Your answer
7. RETREAT DURATION *
How many days are you attending?
8. TOTAL FEE PAYABLE *
Include all add ons in total i.e. linen, bus ( Account no: 03-1355-0650146-00 )
Your answer
9. DEPOSIT PAID *
Minimum $100.00
Your answer
10. *
MORE ABOUT YOU
11. FOOD REQUIREMENTS (if any)
All meals are vegetarian and cooked onsite. Please indicate any special dietary requirements e.g. vegan,dairy/gluten free. There is no access to a kitchen for preparing your own food.
Your answer
12. MEDICAL
13. YOUR YUAN GONG PRACTICE *
Please specify which of the following forms you do not know or would like tuition for.
Required
14. LENGTH OF PRACTICE *
How long have you been practicing Yuan Gong?
Your answer
15. BUDDY SYSTEM
Would you like to be linked to a buddy?
Do you have a preferred person you would like to buddy with?
Your answer
16. TEACHERS PARTICIPATION
Would you like to be involved giving a presentation, teaching or demonstration?
Your answer
17. NEXT OF KIN *
Required in case of emergency. Name, Contact phone, email, relationship
Your answer
18. ANY ADDITIONAL COMMENTS OR INFORMATION YOU WOULD LIKE TO PROVIDE
Your answer
CAR / RIDE SHARING (if you have spare seats to/from Wainui)
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