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Retreat Registration

(Please fill out a separate form for each individual)

Retreat Title:
Cost:
Event Dates:
How did you hear about this Event?
Your Name:
Your Street Address:
City: State: Zip Code:
Home Phone: Work Phone:
Email:
Occupation:
 
To assist us with room assignments:
Gender:   Male    Female
Would you like to room with a specific person?  No Yes
If yes, please give person's name:
Are there any medical emergency response situations we should know about?
Medical/Dietary restrictions or special foods required?
Doctor's Name: Doctor's Phone #:
Emergency Contact: Contact Phone #:
   
Do you currently practice Meditation? Yes: No:
How long have you been practicing?
What is your current Practice?
What prior retreat experience have you had?
 
Do you need a ride? Yes: No:
Can you provide a ride? Yes: No:


Mary says:  "You keep on going back to compulsions because you don’t know how to heal your compulsions, nor do you know how to get to what you were truly hungry for—a deep and satisfying connection with yourself and with life. No wonder you have had moments—and maybe even days and months—when you were depressed and overwhelmed, sure that your compulsions are proof that you are not okay and that you will never be free of them.  Many of us have gone on this way for years, lost in our head, while our feelings tried to grab our attention and our compulsions tried to keep them at bay."


Copyright © 2005 Mary O'Malley, Awakening.  Rights are reserved in all media.