Retreat Registration Te Manawa June 14-16
Where do you live ? (city or town)
Emergency Contact Person and Mobile Number
Any current health problems?
Are you taking any medication?
Any past health conditions or surgery?
Your Food Needs:
The evening soups and lunch meals will be vegetarian. please bring your own breakfast. Ticking the box below will make food planning easier as a group
no special requirements
Please specify anything else you would like the organizers to know
How often do you practice Qigong?
I haven't learnt any Qigong yet
every now and then
at a weekly class
a few times a week
Which Yuan gong methods have you learnt ?
Tian Yuan (gathering qi)
Di Yuan (standing form storing qi)
Ren Yuan (stretching qi)
Xia Yuan (organ healing method)
Zhong Yuan (Microcosmic circuit)
Tong Yuan (heart opening and healing meditations)
Ling Yuan (meditations to work on the patterns)
I am new to Yuan gong
Which of the Methods would you like tuition on during the retreat? (we will choose what best suits group but input appreciated)
What would you like to experience at this Retreat?
you can tick more than one
mindfulness and meditation
to learn self healing techniques
time and space for myself
connection with others in a meaningful way
be inspired and recharged
expand my knowledge of Qigong
learn more about patterns and how to change them
Investment for the two day retreat is $ 350 including dinner and accommodation and tuition for two days.
Please understand accommodation is limited and we will do our best to accomodate your wishes.
Single room add $25 per day to basic rate
Twin Share cabins/in main house add $10 per day to basic
Triple share (no extra charge)
Please pay into 123494005895000 Account name: NJ Meijer (REF: your name/ Code:June retreat) (see refund policy below***)
I have paid $100 deposit and will pay the remainder in full by 14th June
I have paid in full
l would like to discuss payment options with you
Thank you for your registration we are already excited about offering this nourishing and uplifting weekend : ) If you have any questions at all please email Natalie
or Rachel at
**** REFUND POLICY***
Fully refundable if you cancel 30 days before event
50% refundable if you cancel up to 7 days before event
No refund one week before event
NB If we can fill the space you will receive a full refund minus 15% admin fees
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service