Easter Retreat Registration 2020
Complete one form per person and click the Submit button at the bottom of the page.
Sunday, April 5 - Wednesday, April 15
First Name: *
Your answer
Last Name *
Your answer
Email *
Your answer
Street Address *
Your answer
City *
Your answer
State/Province *
Your answer
Postal Code *
Your answer
Country
Your answer
Cell phone *
Your answer
Age *
Your answer
How long have you been practicing meditation? *
Choose the answer that best describes it
Gender *
Required
Do you practice meditation using the Six Rs methodology? *
Required
Briefly describe your meditation experience. *
Your answer
Are you mobility-impaired and rely on support? Please explain.
Your answer
Menu Selection *
How will you get there? *
Required
Will you volunteer to offer a ride to out of town participants by stopping at SFO or San Jose Airports on your route to and from the retreat?
Do you have special dietary or medical needs?
A retreat manager will follow up to review your special needs.
Your answer
Payment
Make checks payable to UIBDS West and mail to: Registrar, 315 N Cottonwood St #12, Woodland, CA 95695. For credit card or PayPal, follow link on the website (3% is added to cover bank service fees).
Choose Type of Occupancy *
Men and women are housed separately. Same-gender partners are in separate rooms. DOUBLE OCCUPANCY REQUIRES A PREARRANGED ROOMMATE; enter roommate’s name below..
Double Occupancy Roommate
Enter name of roommate below. (Roommate must also register for the retreat.)
Your answer
Questions?
Enter your comments below, or email Lynn at lynn.metta@gmail.com
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service