2022 Leura retreat registration

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

Email *

What's your name? *

Who's an emergency contact, both name and number? *

I would like *

A twin share with ensuite for $450

A private room for $550

Any food allergies or dietary restrictions?

Are you fully vaccinated against covid? *

Yes

Decline to disclose

Other:

How will you be getting to the retreat center? *

I'll be driving

I'll be taking public transport

Other:

Would you like to rent sheets, a pillowcase, and a towel from the retreat center for $10? You'll pay this to the center on arrival, not with your registration fee, but they asked us to get a count for them. *

Sure, sounds good!

No thanks, I'll bring my own.

Do you currently have, or have you in the past been diagnosed with or treated for, any mental health conditions? If you're certain we already know this info about you (eg you've been on a retreat with us in the past and this information hasn't changed), it's OK to leave this blank. If you'd rather talk about this privately, please leave it blank and contact Tucker. We do not usually exclude people based on this information, but it's helpful for us to know, as it can change the way meditation might affect you.

By typing my name below, I am agreeing to the waiver found at this URL: https://meditatewithtucker.com/retreat-waiver/ My name below constitutes my electronic signature and is a binding equivalent of an ink signature. *

I am going to send payment for the retreat within the next few minutes, or I've already sent it. *

Of course, Tucker! It must be annoying when people sign up and don't pay. You'd need to reconcile the two registration lists and then contact people who only paid or only registered. I value your time!

No, Tucker. I'm really just here to pester you, with no serious intention of actually attending a retreat. Honestly, I just like filling out Google Forms, and I thank you for the opportunity.

Other:

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