Dependent Origination Symposium 2023

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete one form per person and click the SUBMIT button at the bottom of the page.

Note about this Google Form: If you're signed in to a Google Account, this Form will auto-save your progress, allowing you to return later to complete the Form. The email address shown below tells you which Google account you're signed in to, that's the account the auto-save will use. The email is not included in your submission. • Also note, the red "*Required" alert is not related to your email at all - it's just the standard indicator that a question is required.

Last Name *

First Name: *

Gender *

Female

Male

Email *

Address *

City *

State/Province *

Zip/Postal Code *

Country *

Cell phone *

Age *

I plan on sharing a room with a family member

Enter their full name. Each family member must complete and submit a registration form.

I have completed at least one 10 day TWIM retreat either online or in person *

Yes

Required

Are you mobility-impaired and rely on support?

Check if applicable

I use a wheelchair.

I use a cane or walker.

I need assistance on stairs.

Menu items all include gluten free selections. *

Vegetarian includes dairy in some entrees.

Non-vegetarian includes meats, fish, and dairy entrees.

Strict vegan.

Do you have special dietary that require supplemental personal foods?

A retreat manager will follow up to review your special needs.

I request dry storage in dining area.

I request refrigerator storage in dining area.

Clear selection

Do you have any food allergies *

Yes

If "Yes", please list your allergies

How will you get there? *

By car

By air and will arrange my own ground transportation

Required

In case of an emergency, please list all of your current prescription medications. *

This is confidential information for emergency use only. Do not include nutritional supplements.

In case of an emergency, please indicate an emergency contact and phone number *

This is confidential information for emergency use only.

How will you make payment? *

Pay fees directly on the website after your reservation has been confirmed by email, A 3% bank processing fee has been included in the total amount of fees due. We are limited to use only these payment options. Single Occupancy = $1025, Double Occupancy = $805 per person, Deposit = $400

Credit /Debit Card

PayPal

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms