Nieuwjaarsretraite 22/23 Beginning Anew - Registration form  
LET OP - DE RETRAITE IS OP DIT MOMENT VOLZET. JE KUNT JE NOG OPGEVEN VOOR OP DE WACHTLIJST.

PLEASE NOTE - THE RETREAT IS FULL AT THE MOMENT. YOU MAY STILL FILL OUT THIS FORM FOR A SPOT ON THE WAITING LIST.

Dit formulier vraagt enkele basisgegevens voor je deelname aan de nieuwjaarsretraite 2022/2023. Je inschrijving is compleet als je betaling is ontvangen. Het zou fijn zijn als je binnen een week zou willen betalen.  

This registration form is the basis for your participation in the new years retreat 2022/2023. Your registration is complete as soon as the payment is received. Please pay within a week after registering. 
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Name *
E-mail *
Age *
Phone number *
City of Residence  *
First language 
Clear selection
Do you prefer to be in a Dutch speaking family / an English speaking one, or comfortable with both?
 *
Will you sleep at Cordium? *
To what extent do you have experience with going to a Wake Up sangha?
Never
A lot
Clear selection
If you go to a Sangha, which one do you visit?
Clear selection
Are you aware that you need to bring a (vegan/vegetarian) dish to share with the potluck lunch on the first day?
*
Do you have allergies we can take in account?
The retreat is organized by a small team, but is carried by the whole group. Is it OK if we contact you to help facilitate one part of the program like cooking, singing the morning gatha, guiding a family or otherwise? We will get in touch with you (depending on your answer).
Clear selection
Name of a relative or friend we can contact in case of an emergency (and how this person is related to you, e.g. 'father', 'girlfriend', 'friend', 'aunt'...):
 *
Phone number of this person:
 *
Do you have any questions, do you want to explain something or do you have information you like to share with us or want us to know of (maybe medical or mental conditions, medicines).
Are you aware that the retreat is fully booked at the moment, and this form gives you a place on the waiting list? If your spot opens up, registration is complete when you’ve transferred the contribution (50 euros).
 *
Submit
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