Please enter the information requested below, then click the Submit button.
For further materials or assistance please contact Jon Yaffe, Registration Coordinator,
Name (First, Last)
Address
City
State, Zip
Telephone
Email Address
Gender
Is this your first insight meditation retreat?
Will you be arriving late? If so, please explain below.
Payment Method
Who should we contact in case of emergency?
Emergency Contact Name & Relationship
Daytime and Evening Phone Numbers
Anything more to add or request? - enter a note below:
Please select the retreat and rooming option you prefer.
The prices shown reflect an early registration discount, and apply only if payment
is received by September 23rd. If paying later, the fee will be an additional $25.
We welcome payment in full, but you can send in an initial deposit of $75 if you prefer, to be followed by the remainder of the fee no later than September 23rd.
A limited number of need-based scholarships are available on request. Apply at least three weeks before the retreat and please register when applying, to assure we reserve a place for you.
To request an application, contact Donna Strickland at stricklanddg@missouri.edu
Registration Form
Please register by September 23rd. Registration closes October 9th.
Note: If you are using the Firefox browser, the field labels below may be out of place. If you encounter this and find it hard to fill-out this form, close Firefox and connect to the internet using Internet Explorer or another browser, if available on your PC. We apologize for this inconvenience.
Gregory Kramer
Insight Dialogue Retreat
With Optional Facilitator Training
