Southern Insight Meditation: Dharma Gathering Registration
There are 2 options for this Dharma Gathering: 3 days (11th -14th January) and 7 days (11th-18th January). Please note that priority will be given to 7 day registrations. The availability of places for the 3 day option will be limited to 10 people, with a waiting list thereafter. The final numbers for the 3 days depends on the number of registrations for 7 days.
Email address *
Gathering dates attending *
Name *
Your answer
Children: Names and ages
Your answer
Address *
Your answer
Contact details: Cell phone; Phone *
Your answer
Please outline in detail your background in meditation, if any (number and dates of retreats and name of teacher, type of tradition, years experience). *
Your answer
System of payment for $50 deposit
Medical History: In order to enable the teacher to provide appropriate guidance and support for you on the gathering, please contact Sarah 027 6693824 if you currently have or in the past have had any of the following. Selecting any category does not mean you will be unable to participate in the retreat. This information is treated as confidential:
Do you require transport to/from the gathering? *
Can you offer someone a ride to/from the gathering? *
Food on the gathering is vegetarian, with a vegan option. For practical reasons, any other diets cannot be catered for unless medically required.
Your answer
Vegan Option *
The fee covers all meals, facility hire, the teacher’s travel expenses, and admin costs. If you are able to, we ask that you pay the full amount, which is the actual cost of your gathering If your financial circumstances preclude this, please pay between 70% - 100% of cost and Southern Insight will subsidise your gathering by the remainder. The balance is payable when you arrive at the gathering. Please indicate if you will need to pay less than the full cost, and the amount you are able to pay:
Your answer
Your answer
Contact person and phone number in case of emergency: *
Your answer
Where did you hear about the gathering?
Your answer
By submitting this form, I agree to take full responsibility for myself during the gathering and to follow the gathering guidelines and the instruction of the teacher. I understand that this gathering is undertaken and continued with the agreement of the teacher(s)
Your answer
Name, date and signature
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service