SnowFlower Retreat Registration 2019

October 18-20, 2019 at Bethel Horizons, Dodgeville, WI
First Name *
Last Name *
Affirmed Gender ID *
2nd Participant First Name (enter x if only 1 participant) *
2nd Participant Last Name (enter x if only 1 participant) *
Affirmed Gender ID (enter x if only 1 participant) *
Roommate Request (couples enter "couple" if desired)
Accommodations (For on-site, check all that apply) *
Address *
City *
State *
Zip *
E-mail *
Phone *
Registration Fee: Onsite at $210 for one, $420 for two; Camping or Offsite $155 for one, $310 for two *
Contribution to Thich Nhat Hanh Foundation
Contribution to SnowFlower Scholarship Fund
If paying by check enter total amount (enter Paypal if not paying by check). Send to SnowFlower Sangha Retreat, c/o Celeste Robins, PO Box 3373, Madison WI 53704, or pay on online through PayPal (see link on retreats page). *
Notes (sleep needs/patterns, dietary needs)
You have permission to share my e-mail as:
Clear selection
Never submit passwords through Google Forms.
This form was created inside of Report Abuse