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The Elder Within
June 23 to 26, 2022
Thursday, 10 am to Sunday, 1 pm
Please arrive by 9 am for check in
Contact us at (360) 320-5343 or
nwsoulquest@gmail.com
We hold all responses below in confidentiality.
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Email
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Your email
Name
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Your answer
Address
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Your answer
Telephone number (Cell or landline?)
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Your answer
Birthdate (optional)
Your answer
Female, Male, or other (optional)
Your answer
This experiential program may catalyze deep inner work. Tell us very briefly about your background in doing inner work.
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Your answer
Health or Medical Issues or accessibility needs you want us to be aware of
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Are your COVID vaccinations up to date?
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Yes
No
Contact me to discuss
Are you currently taking any prescription, over-the-counter medications, or recreational drugs? If so, please list.
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Who to notify in case of illness or injury and their contact info (Phone, Text, etc.)
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Your answer
Any food restrictions? Use "Other" for multiple restrictions, and note what they are. We'll let you know if we can accommodate them.
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None
Vegetarian
Vegan
Dairy-free
Gluten-free
Other:
What fee do you intend to pay?
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$325
$495
$675
Other:
How are you sending your $200 Deposit
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Deposit by snail mail (payable to Anne Hayden, PO Box 181, Clinton, WA 98236)
Deposit by PayPal (send to:
nwsoulquest@gmail.com
) (Please add 3% PayPal fee)
Deposit via Zelle (use
nwsoulquest@gmail.com
as payee)
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