Register Here Already Paid Your Deposit? Click Here to Complete Payment Book Your Spot Register here to book your spot on our amazing 'silent' retreat, the Journeying Within retreat. We are so excited to have you! 1 Get Started2 Your Details3 Health Details4 Register Which retreat would you like to sign up for?*Choose your retreat dates.6th-12th August 20215th-11th November 20214th-10th March 202215th-21st July 202218th-24th November 2022Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Your Date of Birth Date Format: MM slash DD slash YYYY PhoneEmail Any dietary requirements? Gluten Free Vegetarian Emergency Contact PersonPlease write here an emergency contact, with a phone number, address and full name.Are you being treated for a current disease / illness?*YesNoAre you taking medication?*YesNoPlease state what kind of medication*If you wish, you may type your family doctors details here.This retreat is totally free of alcohol and all drugs, other than prescription medication.*I agree that this retreat is totally free of alcohol and all drugs, other than prescription medication. I have read and understood the above policy. The full price is $970 for the retreat package. Choose a payment option for your booking:*We offer a number of payment options, to make sure anyone anywhere can experience this opportunity. Please feel free to call with further questions.Place Deposit Now (Remainder Paid no less than 7 days from retreat commencement)Divide into 6 Monthly Payments (Credit or PayPal)Pay in fullPayment typeWould you like to pay via;Credit card / PaypalBank DepositBank DetailsAccount Name: Elizabeth Shelton BSB: 064 428 A/c No: 10219344 Please submit the transfer within 7 days of sending this form. your booking will only be confirmed once the payment is received. I understand the above.Total $ 0.00
