JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Vallecitos 2022 LGBTQIA+ Retreat Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Please re-enter your email address
*
Your answer
First Name:
*
Your answer
Last Name:
*
Your answer
Phone:
*
Your answer
City/Town
*
Your answer
State/Location
*
Your answer
Postal Code
*
Your answer
Age:
*
Your answer
Race: Check all that apply
*
Native American
Asian
Black
Latinx
Pacific Islander
White
Other:
Required
Ethnicity:
Your answer
Sexual Orientation
*
Your answer
Gender Identity Please list below.
*
Your answer
Other identities you would like to share with us:
Your answer
Are you new to meditation practice?
*
Yes
No
If you answered NO above: How long have you been practicing meditation and with what traditions, teachers or centers?
Your answer
Is this your first residential retreat?
*
Yes
No
If you answered NO above: Is this your first retreat at Vallecitos?
Yes
No
Clear selection
If this is NOT your first residential retreat: Please list residential retreats you have attended (where, when, how long, and with whom).
Your answer
Why do you want to attend this retreat?
*
Your answer
Will you need a scholarship for this retreat. If so, do you need a partial or full scholarship? [This question is for planning purposes only and will NOT affect your application.]
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Vallecitos Mountain Retreat Center.
Report Abuse
Forms
