2026 Alaska Mindfulness Retreat Registration  Form  |  August 27- 30  |  Chugiak, AK
Please make sure you click SUBMIT at the bottom of the form

Event Timing: August 27 @ 4:00 PM to August 30 @ 1:30 PM
Event Address: Birchwood Camp, Chugiak, Alaska
Contact us at: alaskamindfulnessretreat@gmail.com
Pets: Birchwood Camp does not allow pets on the property.
If you do not hear from us within a week please contact us.
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Name *
Phone *
Email *
Age *
Gender *
City *
State *
Accommodations
 *
Sliding scale depending on income 

Camping @ $350 - $500
Shared cabin with bunk beds @ $525 - $650
Do you snore? (Leave blank if you are camping or don't snore.)
Required
Payment Amount *
 Total Retreat Registration Payment
Emergency Contact *
EMERGENCY CONTACT INFORMATION
Name and Phone Number
BIPOC Dharma Sharing
OPTIONAL QUESTION: Are you BIPOC - Black, Indigenous, People of Color-  and would you like to join a BIPOC dharma sharing group at this retreat?

Liability Waiver *
By checking the box below, I and all parties on this registration relieve Birchwood Camp, and Floating Leaf Sangha, from all liabilities in the event of any injury or illness incurred while attending this retreat at Birchwood Camp.
Required
Pay *
NOTE:  SPACE IS LIMITED & THE RETREAT IS NEARLY FULL. PLEASE COMPLETE & SUBMIT THIS FORM TO INDICATE YOUR INTEREST IN ATTENDING, BUT HOLD OFF ON PAYMENT UNTIL YOU RECEIVE A CONFIRMATION EMAIL.  Please contact us with any questions: alaskamindfulnessretreat@gmail.com

Once you are confirmed to attend the retreat, there are 3 ways to pay.

1) Venmo--@Sharon_Gorman 

2) Online payment with Global Credit Union(GCU)--easy for any Alaskan with online banking. and a GCU account.

Sign into your GCU.  Choose Transfers and Payments.  In the drop down Menu for "To" choose "Other Global Credit Union Member Accounts", Last name--Alaska Mindfulness Retreat, Account Number-5441397, Account Type--Checking

3) Mail a check--make check out to "Alaska Mindfulness Retreat". Mail to Alaska Mindfulness Retreat  POB 2087 Homer AK 99603
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