Form - Residential Meditation Retreat - Satipañña Insight Meditation Toronto

Welcome to the online application form.

Please note that all questions with an asterisk must be completed for your form to be accepted. Carefully fill out the form and do not omit anything.

You will receive an e-mail acknowledging receipt of your application upon successful completion of this form.

If you have any physical or emotional challenges that might make full participation in the retreat difficult, please speak to one of the teachers before completing the application.

Retreat*

Type of Retreat*

Start Date*

End Date*

Location*

Personal Details

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Transportation Details

Will you be driving to the retreat?*

Can you provide a ride for others?*

How many passengers can you take other than yourself?

From which subway stop could you pick up others?

Approximately what time will you leave Toronto (24H)?

Do we have your permission to include your first name, email address, and phone number on our car pool list which will be distributed to retreat participants?*

The listing of names and contact information helps with the co-ordination of car pooling and is greatly appreciated

Do you need a ride?*

Please provide any details regarding transportation

Accommodation Details

Gender?*

Please select the one which you identify with. Examples of transgender or gender-diverse refers to gender-fluid, gender queer, or agender.. If you feel none of these adequately describes your gender, please select other and fill in the subsequent text area.

Please provide gender details for "other" (in question above)*

Age?*

Please enter a number from 10 to 99.

Do you snore?*

Do you have a sleep disorder?*

Explain sleep disorder*

Please note any dietary restrictions.

Additional Information

Where did you hear about this retreat?

Do you receive e-mail notifications of S.I.M.T. retreats?

If you have particular questions or concerns that you would like to share with us, including health problems, please note them. This would include asthma (or other respiratory issues) and immune system concerns.

If you wish to be informed of upcoming retreats and teachings, please sign up for our newsletter.

Prior to the retreat, please review the retreat guidelines on our website.

Emergency Contact Person

Emergency Contact Name*

First Last

Emergency Contact Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Phone*

Emergency Contact Email*

Enter Email Confirm Email

Payment Details

When would you like to pay?*

Now (with my credit card)

To secure my place in this retreat, I will submit a cheque. The cheque must be received by SIMT by the registration deadline.

Retreat Cost - 8 days, 7 nights*

Residential Retreat Registration Fee

Regular

SIMT Supporter

Scholarship

Retreat Cost - 7 days, 6 nights*

Residential Retreat Registration Fee

Regular

SIMT Supporter

Scholarship

Retreat Cost - 7 days, 6 nights*

Residential Retreat Registration Fee

Regular

Regular (Semi-Private)

SIMT Supporter

SIMT Supporter (Semi-Private)

Scholarship

Retreat Cost - 6 days, 5 nights*

Residential Retreat Registration Fee

Regular

SIMT Supporter

Scholarship

Retreat Cost - 5 days, 4 nights*

Residential Retreat Registration Fee

Regular

SIMT Supporter

Scholarship

Scholarship Cost*

Please enter the scholarship amount that was agreed upon with SIMT

Total Fee

The following total will deducted from your credit card when you submit below. If you choose to pay by cheque, the cheque must be received by SIMT by the registration deadline.

Credit Card

Card Details

Cardholder Name

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Form – Residential Meditation Retreat

Residential Retreat Registration Form

Personal Details

Transportation Details

Accommodation Details

Additional Information

Emergency Contact Person

Payment Details

Important Links

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