Retreat Registration

First Name*

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Is this your first multi day meditation retreat?*

Yes
No

Age*

I will be attending:*

Three nights
Five Nights

Room Preference

Shared Room
Single Room

We can't guarantee single rooms but will make note of your preference. If you have a condition that makes sharing a room difficult for others, such as snoring or using a CPAP machine, please let us know in the box below.

Specific information on rooming needs.

Seating Preference

Chair
Floor/cushions
Chair and Floor/cushions

Special Needs

Chemical/Fragrance Sensitivities
Ambulatory Difficulties
Hard of Hearing

Dietary Needs

Meals will primarily be vegan with some dairy options. Please include any allergies or other pertinent information in the additional notes box below

Vegan
Gluten Free

Upload Vaccination and Booster Card*

Accepted file types: jpg, jpeg, gif, png, pdf, heic, maxfilesize:256mb, Max. file size: 256 MB.

If you have trouble uploading, please send separately to onedharmaretreat@gmail.com

I wish to support retreat scholarships with a donation. Please write amount below and add to your retreat fee. Thank you!

Add any additional notes here.

Emergency Contact*