Register Here Already Paid Your Deposit? Click Here to Complete Payment Registration Register here to book your spot on our amazing 'silent' retreat, the Journeying Within retreat. We are so excited to have you! 1Get Started2Your Details3Health Details4Register Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Which retreat would you like to sign up for?*Choose your retreat dates. 4th-10th March 2022 Booked out 15th-21st July 2022 18th-24th November 2022 10th-16th March 2023 9th-15th June 2023 27th October-2nd November 2023 Your Date of Birth 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?* Yes No Are you taking medication?* Yes No Please 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. Payment typeWould you like to pay via; Credit card / Paypal Bank Deposit The full price is $1020.00 for the retreat package.*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 $100 Deposit Now (Remainder Paid no less than 7 days from retreat commencement) Divide into 6 x $175 Monthly Payments (Credit or PayPal) - (Total $1050) Pay in full - ($1020) The full price is $1020.00 for the retreat package. Bank Deposit*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 $100 Deposit Now (Remainder Paid no less than 7 days from retreat commencement) Pay in full - ($1020) Bank 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.Todays Total $ 0.00 Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
