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Fall Retreat 2022 Registration
INTAKE FORM for the 3-day silent retreat.
Led by Aaron Knowles Dias, October 13-16th retreat at Pumpkin Hollow Retreat Center in Craryville, NY.
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Email
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Your email
Name
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Your answer
Are you registering for a SHARED room or PRIVATE room?
Shared Room (with 1 - 2 other guests)
Private Room
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Are you bringing a friend?
Yes
No
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If yes, then what is the friend's name?
Your answer
Any requests about roommates or accommodations?
Your answer
Friend's Discount
If you and a friend sign up together, you both get $50 off your retreat. (Either of you can select the option for a 70 minute private lesson with me instead; $130 value.)
Everyone is a vegetarian while visiting Pumpkin Hollow.
And much of the food is grown from the garden or at least organic!
Dietary Restrictions
Dairy free
Gluten free
Other:
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What would you most like to get out of this retreat?
Your answer
Do you have any physical injuries that should be considered during yoga, reiki, extended sitting, or getting around the retreat center?
Your answer
Emergency Contact Name
Who should we call in case of an emergency? Name + Relationship
Your answer
Emergency Contact Phone Number
Your answer
Anything else that you want to share or ask?
Consider what would be most helpful as I plan to accommodate your stay and facilitate your retreat experience.
Your answer
If you want to coordinate travel to / from retreat please use the Ride Share spreadsheet.
https://docs.google.com/spreadsheets/d/1fbdXgDpNXxzZ0FOnTzeDDMJDR5wK9QKSwlpFX6YpJLs/edit?usp=sharing
Looking forward to being there with you soon!
Send me a copy of my responses.
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