Retreat The Radical Act of Stillness 5th - 9th June 2023 Menorca
Fill out the form carefully for registration
Student Name
First Name
Middle Name
Last Name
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Male
Female
N/A
Student E-mail
example@example.com
Mobile Number
-
Area Code
Phone Number
Where will you be travelling from and to ?
Which accommodation type would you prefer ?
Room 1 €1,150 Queen Room for private single occupancy
Room 2 €755 shared room for 4 people with a private bathroom
Room € 725 shared room for 3 people with a shared bathroom with room 4
Room 4 €755 shared room for 2 people with a shared bathroom with room 3
Please share a few words on why you would like to join the retreat.
Please tell us about any previous experience of yoga & meditation or Chi Kung that you have had (no previous experience is required )
Please tell us what your expectations are for the retreat.
Please tell us what you think you may find challenging .
Do you have or have had in the past any injuries or medical conditions , sleeping disorders, eating issues, mental health issues or depression ?
Is there anything else you would like us to know ?
Please tell us if you have any food allergies or dietary requirements so that the cook knows.
It is a requirement that all participants make arrangements and agree to be present on retreat from the scheduled arrival time to the finish . Thank you.
I agree
The retreat experience requires that you are happy not to partake of alcohol , smoking or any other stimulants during the course of the retreat.
I agree
I agree to keep all communications during the event confidential : including also materials shared by the teacher.
I agree
I agree that I have and maintain full responsibility for my physical and mental health and well being "
I agree
I have read and agree to the cancellation policy of 100% refund of full amount 60 days before the start date. No refund less than 60 days before. In the instance you wish to cancel your place can be transferred to someone else you know who wishes to take your place , upon your organisation of payments for €25 admin fee. Please ensure you take out travel insurance to cover curtailment or cancellation including COVID. We are not able to refund for COVID.
I agree
Submit Application
Clear Fields
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform