Connecting with Our Hearts: IMS’s Final Family Retreat (5 days) - FAM

July 16 – 21, 2014 (Wednesday to Monday)

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 $680.   (This represents IMS's actual cost for this program.)
Mid $585
Base $485
 
Amount you will pay today:
Sustaining $680
Mid $585
Base $485
Deposit $180

Retreat Center Questions

Male Female  
 
Yes No
Yes No
Yes No
Yes No

Previous Meditation Experience



Mailing Information

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
 

Financial Assistance Application

 
 
 
Yes No
Yes No
Yes No
Yes No

Family Information

Please enter the Full Name, Gender, Year of Birth and Rate you will pay for each accompanying family member.

Rates for the Family Retreat:

Sustaining
Mid
Base
Scholarship
Adult:
$680
$585
$485
$160
Child:
$355
$295
$235
$160

 
 
Male Female  
 
 
 

 
Male Female  
 
 
 

 
Male Female  
 
 
 

 
Male Female  
 
 
 

 
Male Female  
 
 
 

Payment Information

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

 
Visa Mastercard

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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