Boundless Heart: an MSC Retreat Registration Form

Cancellation policy.

Cancellations received up to or before 1 month before the event – the fee will be refunded less $150.
Cancellations received up to 10 working days before the event – 50% of the fee will be refunded.
Cancellations received 10 working days or less before the event – no refund will be made.
However, if a substitute person can be found so that we are not impacted financially there will be a 50% refund.

Please note that the cancellation policy applies to absence due to illness like Covid.

It is recommended that you have attended MBSR or MSC and have attended at least one sient day retreat. You will need to be able to care for your own emotional and physical needs on this retreat (Although of course you can reach out to Adele or Maggie if necessary).

It is important to intend to be at the retreat for the entire time. This makes a difference to others experience also.

Fields with a red asterix are required to be filled out.

Name

Preferred First NameLast Name

Pronouns if you wish

E-mail

example@example.com

Mobile Number

Format: 0000000000.

WhatsApp contact for yourself :

An optional WhatsApp group will be run in the lead up and for some time after the retreat.

Card holder or pensioner number and expiration date (if applicable):

Seniors card not eligible

City of residence:

Emergency contact name:

First NameLast Name

Emergency contact number

Format: 0000000000.

Current life situation / occupation:

How did you first hear about this retreat?:

Please briefly describe your previous experience or training with mindfulness or self-compassion.

Do you have any current or recent physical, emotional or spiritual concerns that might make attending this retreat difficult for you at this time? Please tick any conditions below that apply so that we can support and care for you properly should this become a concern.

Other

Please provide further details on any items you ticked above. In addition, if you have recently experienced any significant life event, traumatic experience or major loss, it would be helpful to note that here, so that the teachers will be aware.

Please ask any questions or concerns that you would like to have addressed by the teachers about the content of the retreat itself. You can use this section to add anything else that would be helpful for you to share with the teachers at this time.

Dietary requirements (vegetarian)

Other

Cost

Single room:	*Shared room:**
$1085 Standard fee $995 Card holder/Pensioner	$885 Standard fee $785 Card holder/Pensioner

*Please let us know in the comments or concern section above if you have arranged a "room buddy". Booking for a shared room is not suitable if you are a snorer.

Payment: If using mobile phone, you may need to click over text rather than box. Tick box and choose appropriate rate.

MSC Retreat 3 nights SINGLE room with ensuite, all meals and teaching.

$1,085.00 AUD Rate

MSC Retreat 3 nights SHARED room with ensuite, all meals and teaching.

$885.00 AUD Rate

MSC Retreat Deposit

Balance required 3 months prior to retreat. Please indicate in comments or concerns section above if you are registering for a single or share room and whether you are a card holder or pensioner.

$150.00 AUD

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Boundless Heart: an MSC retreat Registration form 14-17 October 2027

Payment: If using mobile phone, you may need to click over text rather than box. Tick box and choose appropriate rate. *

Payment: If using mobile phone, you may need to click over text rather than box. Tick box and choose appropriate rate.