Womxn's Online Retreat Registration

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January 14-17, 2021

Email *

First Name: *

Last Name: *

Street Address

City, State, Zip *

Phone number: *

What are your pronouns? *

List your prior residential retreat experience. *

What inspires you to do a retreat at this time? *

Waiver of Liability: I acknowledge that I have voluntarily agreed to participate in the Women's Online Retreat offered by Meditation Coalition from January 14-17, 2021. I am also aware that this is a silent meditation retreat and participants may experience intense psychological, spiritual and/or physical states of mind and body arising from the meditation and associated retreat activities. I am voluntarily participating in these activities with full knowledge of the risks involved.I have read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Meditation Coalition. *

I agree

I disagree

By typing your name here you agree to the above Waiver of Liability and the Cancellation Fee Policy listed on the payment page *

Date *

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A copy of your responses will be emailed to the address you provided.

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