Registration: YSDC Insight Meditation Retreats

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

2024 YSDC Insight Meditation Retreats with Rebecca Bradshaw
May 10-12, and May 12-19, 2024, at The Jesuit Spiritual Center in Milford

Registration deadline is April 15, 2024, or until all spaces are reserved.

You will be prompted to submit your deposit after completing this form. If you need to revisit the payment page, it can be found here: https://www.ysdharma.org/2024-vipassana-retreat-payments/

Reach out if you have further questions. For registration help, contact Alan Newman at newman2@uakron.edu. For questions about retreat life, contact Linda Potter at lindap@woh.rr.com.

First Name *

Last Name *

Email *

Street Address *

City *

State Abbreviation *

Zip Code *

Phone number *

Gender identification *

This helps us with room assignment. Each participant has a private room.

Dietary restrictions *

None

Dairy-free

Gluten-free

Required

Retreat experience *

This is my first residential (in-person) Vipassana retreat

I have attended a residential (in-person) Vipassana retreat in the past

Which retreat will you attend? *

Deposits are refundable if canceled by April 15. This allows us time to add someone if there is a waitlist and avoids any charges for accommodations that will not be used.

Retreat Fees

Weekend May 10-12: $320

Week May 12-19: $1150

9-day May 10-19: $1470

I plan to attend the weekend (May 10-12), and I’m submitting a $100 deposit

I plan to attend the week (May 12-19), and I’m submitting a $200 deposit

I plan to attend the weekend and week (May 10-19), and I’m submitting a $300 deposit

Scholarship

Please request a scholarship if needed. Funds are available from donations. If you require more or less than the 50% scholarship amount, contact Alan Newman at newman2@uakron.edu.

I am requesting a 50% partial scholarship for this retreat

Contribute a donation

I would like to donate to the Yellow Springs Dharma Center/Scholarship Fund. The amount is indicated below, and I will submit with my deposit.

Deposit and balance acknowledgment *

Important: in order for your registration to be complete, you must submit your deposit using the link that can be found at the top of this form or on the confirmation page after submission.

Please acknowledge that you will submit your deposit and that you understand you will have to pay the balance of the retreat fees before the retreat begins. You can pay online up to one week prior to the start of the retreat. After that date, you can only pay the balance in person with cash or check at the retreat. Please note that we cannot accept credit card payments on-site.

Yes

Required

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