International Earth Retreat 'Love is freedom'

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Email *

Family Name *

First Name *

Age *

Address *

Country *

Telephone *

Email *

Gender *

Female

Male

Other (specify your situation and needs for lodging in the comments)

Health, Medicines and personal background

Please share details about your health, medicines and your personal background. All this information is strictly confidential and only the registration team and monastics will receive this information, in case needed.

Do you have any physical limitations that could have an impact on your capacity to participate in the daily schedule/ activities of the retreat?

If so, please let us know here:

Are you taking medicines for mental health at this moment ? If so, please let us know the name of the medicines as well as the treatment you will be taking during the retreat.

Please let us know the details of these medicines

If you answered yes to this question, please write down the name and phone number of your doctor.

Have you recently or in the past suffered of mental health problems such as depression, anxiety, bi-polarity, automutilation or strong suicidal thoughts?

If so, please give details and share with us which treatment(s) you have followed.

Is there any other information about your current life situation that you would like to share with the sangha or which you would think to be useful for us to know?

Contact number in case of emergency (please also note the name of the person as well as your relation with them)
*

Have you received the 5 or 14 Mindfulness Trainings?

Yes, the 5

Yes, the 14

Yes the 14 as well as the lamp

Clear selection

I think I will come *

With my own car

With public transport or car sharing

other

Housing and price
*

I would like to be in a 4 person room with shared shower/toilet - 450€

I would like to be in a double room (with shared shower/toilets) - 600€

I would like to camp( and I take my own stuff for camping) - 350€

Other: (please explain in the comments)

Required

Are you coming with another person with whom you would like to share the room? If yes: with who? (this person will need to sign up seperately)

I am ok to take a covid test if I have symptoms of covid or if I am contact-case. I agree not to come in case I have covid
*

yes

Comments

Payment *

Wire transfer

French cheque

Required

Wire Transfer

Please make the wire transfer to Communauté Bouddhique Zen; Crédit Agricole; Place du Chanoine Heroux, 93330 Neuilly sur Marne, IBAN: FR 76 1820 6000 2940 4951 9700 179, BIC: AGRIFRPP882

Chèque

Please put your cheque on the name of CBZ and send it to Maison de l'Inspir, 8 Rue des Fans, Lieu-dit Montflageol, 77510 Villeneuve-sur-Bellot, France

When making a wire transfer or writing a cheque, please note the name of the retreatant and the name of the retreat

Please send the proof of payment to inscriptions@sourceguerissante.fr

A lotus to you, a Buddha to be

Cancelation policy

If you would like to cancel (for whatever reason) :

- Your payment will be refunded if you cancel more than 3 weeks before the arrival date of the retreat (minus 50 euros cancelation fee)
- If you cancel less than 3 weeks before the arrival date, you will be refunded 50%
- If you cancel on the day of arrival or later, there will be no refund.
*

I accept the cancelation policy

Required

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

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