Teen Retreat (4 days) - TR

June 23 – 27, 2018 (Saturday to Wednesday)

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

IMS's fees are on a sliding scale basis, and do not include compensation for the teachings. There will be an opportunity to offer donations to the teachers and to IMS at the end of this retreat.

Please note that any amount paid above the Base rate is a tax-deductible donation.

Sliding scale rate you select:
Benefactor $880 
Sustaining $545  (This represents IMS's actual cost for this program.)
Mid $450
Base $355
$180 Scholarship $155 Scholarship $135 Scholarship
  (Please select the highest rate you can reasonably afford. This allows us to better meet the growing number of requests for financial aid.)
 
Amount you will pay today:
Benefactor $880
Sustaining $545
Mid $450
Base $355
Deposit $355
Scholarship Deposit $135

Please read our registration information and cancellation policy.

Retreat Center Questions

 
Yes No
Yes No
Yes No
Yes No
 
 
 
Female
Male
Transgender or gender diverse
    (e.g. gender queer, gender fluid, agender, etc.)
 
Floor for all genders, or no preference
Floor for women
Floor for men

People of Color Affiliation

 
 
Yes No

Teen Retreat

Please make sure we have name and contact info for both the teen and a parent or guardian, and also note that we need to receive a waiver signed by both BEFORE we can confirm you into this course:

Click here to download or print the waiver

 
 

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

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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