Retreat Application
Welcome! Please answer the following questions as completely and honestly as possible. All your responses will remain confidential. Shortly after you submit this form, I'll be in touch to arrange a brief online call—a chance for us to get to know each other a bit more and explore how this retreat can be of benefit for you.

Once you're approved to join the retreat, a $500 deposit is required to reserve your spot, with the balance due by May 1. Total retreat cost is $3250.

Cancellation and Refund Policy
—A non-refundable deposit of $500 is required to secure your registration. This will be applied to the overall retreat cost.
—The remaining balance must reach us by May 1—if not, your place may be offered to someone on the wait list, and you will forfeit the deposit.
—100% of balance will be refunded if cancelled up to 60 days before the retreat start date
—50% of balance will be refunded if cancelled 30-59 days before
—Cancellations less than 30 days before are nonrefundable
—Installment payment plans possible; contact Kevin at rigdzindorje@protonmail.com

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Name *
Email

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Phone

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Date of Birth

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DD
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Passport Number and Country

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Current country of residence + time zone
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Profession
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How did you hear about this retreat?
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Any dietary preferences or food allergies?
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Room Preference
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Required
Name of preferred roommate (if any):
Interested in July 9 Machu Picchu trip? (requires separate registration and payment)
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Required
Emergency Contact—Name and relation
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Emergency Contact—Phone and email
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