Registration: 2017 New Year’s Retreat - Guelph (2017-12-29 - 2018-01-01 )

USER INFORMATION
First Name:
Last Name:
Address:
City:
Country:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Confirm Email:
Emergency Contact Person:
Emergency Contact Person Telephone:


Personal Information

This information helps us make your retreat experience as smooth as possible.

Gender:
Male  
Female  
Transgendered or gender diverse (e.g. gender fluid, gender queer, agender)  
Year of Birth (YYYY):
Do you snore?:
yes  no  

Meals will be vegetarian with dairy and eggs. We cannot always accommodate special needs. If you have any special dietary needs for health reasons, please explain here.

Special Dietary Needs:
Dairy Free
Wheat Free
Gluten Free
Other
Please explain your special dietary needs::

Please indicate any physical disabilities or special needs to assist in assigning your room.

Special Needs:


Mailing List

Your name, address, phone number and email address will be entered into our computer database so you can receive information about future retreats.

We do not sell or share our mailing list with other organizations.


Mailing list subscription:
Yes, I would like to be on the mailing list


Meditation Experience

Have you attended a TNI retreat before? :
Yes  No  
Have you attended a retreat elsewhere before?:
Yes  No  
Have you previously practiced insight meditation (vipassana)?:
Yes  No  
Have you practiced any other type of meditation?:
Yes  No  


Ride Share

Ride-sharing is a great way to simplify retreat transportation while being conscious of our impact on the environment

Would you like to participate in ride-sharing?:
Yes  No  


Scholarships

Scholarships are awarded on the basis of financial need only and offer up to a 50% discount off the low rate.


Would you like to apply for a scholarship for this retreat?:
Yes  No  


Donations

Please consider making a tax deductible donation, as retreat fees cover only a portion of our total expenses.


Would you like to offer a donation to TNI today?:
yes  no  


Security Code

Please enter the security letters as they appear in the box on the right. This helps us avoid fraudulent automated use of our forms.


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