Dharma Treasure Intake and Practice History Form
This form is for all applicants planning on attending a retreat at Dharma Treasure Retreats at Cochise Stronghold. We respectfully request that you answer all questions completely and honestly.

This form is confidential and will be seen only by Resident Teachers and the Cochise Stronghold staff.
Email address *
Today's Date
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Name *
Your answer
Address - Number & Street *
Your answer
Address - City, State *
Your answer
Address - Zip Code *
Your answer
Address - Country *
Your answer
Mobile Phone *
Your answer
Other Phone
Your answer
Retreat Dates *
Do you have a particular time frame in mind for your Solo Meditation Retreat?
Your answer
Transportation Needs *
Do you anticipate needing transportation pickup or logistics support to the retreat center? (Note: additional fees may apply)
Your answer
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