Registration for Ren Xue Retreat Ireland
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 Cathy at
All information you provide will remain confidential.
Given name and surname
2. Email Address
4. Phone Number/s
Please provide the best number/s to reach you on
5. What is your age?
18 - 30 years
31 - 50 years
50 - 70 years
71 or older
7. Emergency contact details
Who can we contact in case of emergency? Please supply name, phone number, email address and relationship to you.
8. Do you have any medical conditions we need to know about?
Please list any important medical conditions you are dealing with at the moment, as well as conditions that may limit your ability to follow the requirements for the Yuan Gong practice. This information will help us with our instructions at the beginning of each session. All information given is regarded as private and confidential. * (If not applicable, enter N/A)
9. Dietary Requirements
10. A limited number of Amatsu treatments are available to book. Please follow the link to find more out about Amatsu therapy;
I wish to book an appointment
I do not want an appointment
11. Total Fee Payable
Please follow the link for payment instructions:
€395 - single room occupancy retreat only
€495 - retreat plus tour, includes extra night plus meals (Tues 25th)
€425 - retreat plus Amatsu therapy appointment
€525 - retreat plus tour plus Amatsu therapy appointment
12. Please select payment method
PayPal ( please add 3% PayPal fee to your payment)
Is there any other additional information you would like to provide?
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