Three-Month Retreat - Part 1 (42 days) - PT1

September 11 – October 23, 2018 (Tuesday to Tuesday)

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 $9,240 
Sustaining $5,710  (This represents IMS's actual cost for this program.)
Mid $4,265
Base $2,820
 
Amount you will pay today:
Benefactor $9,240
Sustaining $5,710
Mid $4,265
Base $2,820
Deposit $375

Please read our registration information and cancellation policy.

Retreat Center Questions

 
Yes No
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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

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

Three-Month Retreat Questions

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





Yes No
 
 
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Yes No

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Yes No
 
 
 

Silence and Renunciation

 
 
 
Yes No
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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.

 
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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