JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Buddhist Detox Retreat
Event Date: July 5th (arrival day) - 7th (Residential Retreat)
Event Address: Karuna Sanctuary -
No. 5 Saywell Road, Katoomba
Contact Details: 0425 173 612
info@ministryofnirvana.org.au
* Indicates required question
Email
*
Record my email address with my response
Where did you hear about this retreat?
*
Metta Centre
Ministry of Nirvana
Other:
First Name
*
Your answer
Last Name
*
Your answer
Sex
*
Female
Male
Other
Address
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Any dietary requirements?
*
Your answer
Allergies or Intolerances?
*
Your answer
Any health conditions or disabilities that we should be aware of?
*
Your answer
Will you be joining with a group? If so please state the names of these group members below. (All participants are required to individually complete a registration form but this information may assist us in organising accomodation)
*
Your answer
Which days will you be attending
*
July 5th
July 6th
July 7th
Other:
How many nights do you intend to stay?
*
1 night
2 nights
I will not be staying overnight
Media Consent: By choosing “Yes” you give consent to the use of photographs, images, videos and audio
recordings of the retreat to be published on websites, Youtube and future publications.
*
Yes
No
Terms and Conditions
I understand and accept the Terms and Conditions mentioned above
*
Yes
No
Terms and Conditions: Karuna Sanctuary
I understand and accept the Terms and Conditions of the Karuna Sanctuary mentioned above
*
Yes
No
Submit
Page 1 of 1
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
