* 1. Contact information

* 2. How did you hear about the retreat?

* 3. Date of retreat you would like to attend {July 22, October 21 - please note that April 30 is fully booked}

* 4. How will you attend?

* 5. How long have you been practicing mindfulness meditation, and how regularly do you meditate?  

* 6. Have you attended a meditation retreat before?

* 7. When, where, and with what teacher(s)?

* 8. Are there any current physical or psychological issues that need to be considered for this retreat?

Please read this section and then continue below.
The fee for the retreat is $95.

* A $50 deposit, as well as the completion of this form, is required to reserve a place in the retreat. This deposit will be refundable until 30 days prior to the retreat; after that the deposit will be non-refundable. * 

You can send a check, along with your registration, to:
25 Mayhew St., Boston, MA 02125
or pay via PayPal.

You will receive email confirmation as soon as this form is received. 
It will include the PayPal link and further information about the retreat.
(Please note that there will be no responses until after March 11.)

A note about cancellations:  A deposit is now requested as a courtesy and commitment to this day of practice. We all have busy lives and often feel squeezed for time. One of the first things to go when under pressure is self-care. Your deposit is a commitment to self-care if nothing else. Additionally, the limited number of spaces makes it so that late cancellations mean someone else may not be able to attend who otherwise could have.

This fee is not intended to be exclusionary. If you are unable to afford this but wish to commit to attend please contact me directly.

I look forward to working with you!


* 9. By clicking this box, I state that I read the above section of text.