Aotearoa REN XUE Retreat 30th/31st May- 6th June 2020

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Please provide accurate information and save a copy of this form for your own records. If you need to alter any information or have any questions please email
Val - valswatridge@gmail.com OR Darryl - stonepapersissors@gmail.com
All information you provide will remain confidential.

*************** PLEASE NOTE WE HAVE A NEW BANK ACCOUNT ***************
Account Name: REN XUE Australasia Charitable Trust
Account Number: 38-9020-0761158-00

Email *

Full Name *

YOUR AREA *

3. YOUR TELEPHONE NUMBERS *

Mobile: Landline:

4. ACCOMMODATION *

All accommodation prices are per person (pp). To qualify for a teacher you must have completed and passed one teaching module .

QUAD BUNKROOM/ENSUITE:

Teachers $545.00 pp

Non Teachers $595.00pp

DOUBLE/ENSUITE:

Teachers $800.00pp

Non Teachers $850.00pp

SINGLE/ENSUITE:

Teachers $945.00pp

Non Teachers $995.00pp

12 BED BUNK ROOM (mixed gender):

Teachers $470.00pp

Non Teachers $520.00pp

STAYING OFFSITE, retreat & food: $450.00pp

OTHER: less days by arrangement Contact Val ( valswatridge@gmail.com)

5. LINEN

Towels & Linen (includes sheets, pillowcase, towel, duvet, pillow)

Yes: $25

Pillow only: $5

If not hiring you need to being your own pillow and linen

Clear selection

6. AIRPORT TRANSPORT

$25.00 per one way trip. Please note the shuttle departure times. You will need to book your flights to connect.

Airport to Wainui. Teacher only day Sat 30/5, shuttle departs airport 12pm.

Airport to Wainui. Participants Sun 31/5, shuttle departs airport at 2pm,.

Wainui to airport Sat 6/6 departs 1pm, arives at the airport aproximately 3pm. .

6a. Bus total

Total bus fares ($25 per one way trip)

7. RETREAT DURATION *

How many days are you attending?

Six days. Please arrive after 3pm

Seven days (all teachers who have completed a Teacher Training module are welcome)

8. TOTAL FEE PAYABLE *

Include all add ons in total i.e. linen, bus ( ACCOUNT NO: 38-9020-0761158-00)

9. DEPOSIT PAID *

Minimum $100.00 ACCOUNT NUMBER: 38-9020-0761158-00 Please note new account number

10. *

Male

Female

MORE ABOUT YOU

11. FOOD REQUIREMENTS (if any)

All meals are vegetarian. Please indicate any special dietary requirements e.g. vegan,dairy/gluten free. There is no access to a kitchen for preparing your own food.

12. MEDICAL

Are you on any medication we should be aware of?

Do you have any allergies?

List any important medical conditions that may effect your progress or participation during the retreat.

I would like to discuss my condition with Dr Jackie Blunt

Have you been admitted to hospital in the last year?

Do you have a history of any psychiatric conditions?

13. YOUR YUAN GONG PRACTICE *

Please specify which of the following forms you do not know or would like tuition for.

Tian Yuan (1st method)

Di Yuan (2nd method)

Ren Yuan (3rd method)

I am a competent practitioner

Required

14. LENGTH OF PRACTICE *

How long have you been practicing Yuan Gong?

15. BUDDY SYSTEM

Would you like to be linked to a buddy? It can be helpful to have someone you can touch base with during the retreat.

Yes

Do you have a preferred person you would like to buddy with?

16. TEACHERS PARTICIPATION

Would you like to be involved giving an individual or shared presentation, teaching a method or being a demonstrator? Please indicate your level of Teacher Training and if you are currently teaching.

17. NEXT OF KIN *

Required in case of emergency. Name, Contact phone, email, relationship

18. ANY ADDITIONAL COMMENTS OR INFORMATION YOU WOULD LIKE TO PROVIDE

CAR / RIDE SHARING (if you have spare seats to/from Wainui)

I can offer a ride

I would like a ride

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