Dec 13- 15 Residential Retreat Registration
Everyone, including Dharma Heart Members, must register in order to attend the retreat. Please fill out the entire form. Your registration isn't complete until you make full payment for the retreat.
Full Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Address *
Your answer
If you are registering more than one person please add their full name below.
Your answer
Are you a member of the Dharma Heart Program? *
Do you use a Cpap Machine when sleeping or do you snore loudly? *
Emergency contact - full name *
Your answer
Emergency contact phone number *
Your answer
Do you have any serious allergies (e.g. bee stings, penicillin, nut allergies, etc.)? *
If yes, please specify and explain how we should best respond in the event of a medical emergency.
Your answer
Do you have any dietary allergies? *
If you indicated you have dietary allergies please list them. Please also indicate if exposure would require medical attention (i.e. anaphylaxis due to peanuts).
Your answer
Would you like to share a room with a specific person? Please write their name below.
Your answer
What seating arrangement works for you? *
How will you be making your retreat payment? (Full retreat payments are due no later than Nov. 10.) *
Required
Please feel free to include any other information you feel we should know. (Not required)
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