Sign up for ONLINE Deep rest meditation retreat with Jaya Ashmore 2.-4.7.2021

Sign up for ONLINE Deep rest meditation retreat with Jaya Ashmore 2.-4.7.2021
Please fill in all fields in English. Write "no" if you don't have any comments.
Name*

First nameFamily name
Email address*
My email address can be shared with other participants at the end of the retreat

YesNo
Phone number*
Birth year*
What is your preferred gender pronoun?*

HeSheOther
If you chose "Other", please specify
Country (and time zone) where you will be during the retreat*
Have you practiced meditation before? (Click all that apply)*

On your ownWith the help of books and recordingsWith a teacher or friendOn a retreatOther (please specify)Not at all
If you chose "Other", please specify
If you have meditated before, please describe - which style of meditation, book, recording, technique, teacher and/or personal experiences have been helpful? If you haven't meditated before, what interests you about meditation now?*
Previous retreats with Jaya or elsewhere - when, where, with whom and how many days (approximate information is ok, especially if there's a lot to list). Any comments you would like to share about your retreat experience.*
Do you have any past or present sleep or eating issues, abuse history or issues, suicidal thoughts or other psychological imbalances? (If yes, please give details of occurrences, treatment and medications if any.)*
Is there anything else that you would like Jaya to know about you, or your life, or your practice for this retreat?
By participating, you take on the responsibility to let us know if you don't want to be recorded during the sessions. These recordings are made available as soon as possible to retreat participants, since people in different time zones cannot attend all the sessions. However, we also share some or all recordings publicly.*

I agree
To register for this retreat you need to agree that you are over 18 years of age and fully responsible for your mental and physical health.*

I agree
I commit to keep all communications from the course confidential: I will not share course materials nor the sharing of other participants with anyone else.*

I commit
The teacher has the right to refuse an application and cancel person's participation if it is seen necessary. The retreat fee is not refundable in case of cancellation during the retreat.
All personal information submitted in this form is strictly confidential and will be available only to the teachers and some of the organizers on a need to know basis. All related material will be destroyed after the retreat.
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