Retreat Registration Form

Silent retreats • personal retreats • day retreats

Welcome to your Retreat

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Registration Form for Retreats

Full Name *

Phone Number *

Email Address *

Address *

Emergency Contact Name *

Emergency Contact Number *

What are you looking forward to about coming on retreat / what would you like to receive from your time?

Is there anything additional that you may which to book in for while on retreat?

• Meditative Peace Class (on 10:30 am Saturday at the start of Silent Retreats)
• Counselling, Coaching and/or Healing Appointments
• I would like to learn more about the above options
• Nothing additional to book at this stage

Do you have any food allergies or other needs that we may need to be aware of?

How did you hear about Pure Meditation & Wellness?

Today's Date *

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