Your Name (required)

Your Email (required)

Postal Address (required)

Postcode (required)

Telephone (required)

Age

Contact person in case of an emergency:

Telephone:

It is important that I have a sense of your background with Qigong, Meditation, Enquiry and spiritual practice, as well as any psychological and physical conditions that may affect your experience of being on the retreat.

Please answer the following questions and include any relevant medical information. This information will be treated confidentially. Thank you

Please list your previous experience of the practices offered on the retreat (required)

Indicate any other spiritual traditions you have been involved with (required)

Do you have any history of physical or mental illness or history of trauma or limitations, which may make aspects of the retreat difficult for you? If yes, please specify

Are you currently taking medication for any physical or psychological condition? If yes, please specify condition and medication

Any additional comments, including any dietary needs

I understand that the retreat is a powerful environment of transformation and I agree to take full responsibility for myself and my inner processes. Please tick box if you agree (required)