Three-Month Retreat - Part 2 (42 days) - PT2

October 25 – December 6, 2014 (Saturday to Saturday)

Complete the information requested below, then click the "Submit Registration" button at the bottom of the form. Once your registration is submitted, you will receive a Confirmation Code — please quote this in any future correspondence. Within a week, you should receive further information from us regarding your registration status.

Retreatant Information

First Name
Last Name
Middle Initial
Email  
Address
City
Country
State/Prov
Zip/Postal Code
Day Phone
Evening Phone
Cell Phone

Retreat Fees

Sliding scale rate you select:
Sustaining $5,090.   (This represents IMS's actual cost for this program.)
Mid $3,790
Base $2,485
 
Amount you will pay today:
Sustaining $5,090
Mid $3,790
Base $2,485
Deposit $375

Retreat Center Questions

Male Female  
 
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Mailing Information

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Financial Assistance Application

 
 
 
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Three-Month Retreat Questions

Please answer the following questions about your meditation, medical and psychological history.
This information is confidential and strictly for the use of the retreat teachers to guide you more skillfully in your practice. It will be destroyed at the end of your retreat.





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Payment Information

Note: Address below must match what is on file with your credit card company or the transaction will be declined.

 
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Additional Donation

I would like to contribute an additional amount to IMS.


I have read the registration information and cancellation policy. Click here to review.

Please submit your registration. Provided you have answered all the questions, a Confirmation Code should immediately appear on your screen. If no code number appears, your application did not go through. Please check that you have completed the form correctly and disabled all script blockers, and submit it again. If you have any questions, contact the Retreat Center by calling 978-355-4378 or emailing rc@dharma.org.



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