Dhamma Dena ICD Retreat Registration
Weekend Retreat for the Insight Community of the Desert
Email address *
First Name *
Your answer
Last Name *
Your answer
Prefered Pronoun
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Phone numbers (list all, indicating cellphone) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender identification *
Race Identification
Your answer
Special Dietary Needs
Please note that we will be offering gluten-free options for all meals.
Do you have any special needs for housing, or for your health?
Your answer
Have you attended a retreat at Dhamma Dena before? *
Are you new to Vipassana meditation? *
Where did you hear about the retreat? *
Required
Scholarship/Work Exchange Requested *
$100 deposit *
NOTE: Your registration is not confirmed without a deposit
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