2018 Winter Retreat Questionnaire: starts Friday, Dec. 28 - Copper Beech Institute
Please fill in the information below as completely as possible.
If a question is not applicable, please leave it blank.
If you use a different name for your PayPal or bank check payment, please indicate it in parentheses so we can match you with the correct registration payment.
Optionally, please provide your phone number with area code. Cell phone # is preferred, in case we need to reach you once you're at the program.
How did you hear about this retreat?
Or, who were you referred by?
Please briefly describe your prior meditation experience.
Please briefly describe your prior experience with meditation retreats
What is your primary interest or focus for this retreat?
Are you affiliated with any meditation groups or organizations?
Do you have any food preferences, restrictions or allergies?
If you have any food preferences, restrictions, allergies, and so on, we will do our best to work with the Copper Beech staff to accommodate them. We may contact you for more details if needed.
Food allergies/other restrictions
Food allergies/other restrictions - details
If you indicated food allergies or other restrictions above, please provide details here.
Disability assistance required?
If you need any disability assistance, please describe your needs below. Otherwise, please leave this blank.
If you have other specific questions or concerns, please let us know briefly below and we'll do our best to respond.
Please mark all of the activities you are interested in helping with before or during the retreat. (Prior experience is helpful for some roles, but training is also available.)
Publicity and communications (prior to retreat, local or online)
Participant services (assisting with check-in and attendee needs)
Meditation room setup (at start of retreat)
Meditation room maintenance
Water service for teachers
Escort for teachers
Not sure, but willing to help beforehand
Not sure, but willing to help during retreat
Volunteering - Experience & Other info
Please briefly describe your experience in the above roles and add any notes regarding your volunteer service you think are helpful.
If you need to finish filling out this form later, or need to update it later with additional details, please take note: After you "submit" the form, you will see a hyperlink that says "Edit your response". Please *save* that hyperlink so you can return to the partially completed form later and add the additional information. (It should work for you to copy & paste the hyperlink into an e-mail or a Microsoft Word document or similar.)
If you have any other questions, please contact the registrar, Ellen Balzé (
A copy of your responses will be emailed to the address you provided.
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