Bringing Mindfulness Home: Retreat Application

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Email *

Name *

I identify as... *

Female

Male

Gender non-binary/gender fluid

Prefer not to say

Other:

Preferred Personal pronouns *

Address including city, state/province, and zip/postal code *

Phone number *

How would you like to pay?

I'm Canadian.I love spelling words like colour & centre. I'll e-transfer $250 to mmeksp@gmail.com

I'm American. It's okay that I spell color without a "u". I'll send $200 to Venmo @Enrique-Collazo

I'm from somewhere else that's probably way cooler. I'll contact you about payment.

I would like to pay by old-fashioned cheque in the mail. I'll contact you for more details.

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Please share any physical or emotional needs that it would be helpful for us to know/you want us to know about.

Do you have readily available access to a reliable internet connection? *

Yes

I'm working on it.

Other:

Previous mindfulness and retreat experience (for example: teachers, years practicing, # of retreats) *

Please describe your current mindfulness practice or experience with mindfulness/meditation *

What would make this retreat successful for you? *

How did you hear about us?

Is there anything else you'd like to add or share. Questions? Issues? Concerns? Jokes? Just nice things you want to say? :)

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