Anytime Anywhere Meditation Retreat at Tergar Samadhi

Phone *	Please include the country code.
Preferred Name	This is the name we will use during the retreat.
WhatsApp Number (if different from phone)	We will be using WhatsApp for group communication and to reach you if necessary. If your What'sApp number is different from the phone number provided above, please enter it here, including country code.
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Language *
Birth Year	It is helpful to know your birth year for room assignments. Thank you.
Gender *
Please choose a room or tent option *
Who are you comfortable sharing a room with? (select one or more)	Men Women Trans, non-binary, not listed
Sleeping Issues	For example, do you snore or use a CPAP machine at night?
Roommate Request	If you have a specific roommate request, please enter their full name.
Special Diet *	All meals are vegetarian by default, but vegan meals are available by request.
Diet Notes	Please describe any special dietary needs or food allergies. We will do our best to accommodate your requests but cannot guarantee it will be possible, we will contact you if there are any questions or concerns.
Emergency Contact Info *	Please give the name, contact information and relationship of who we should contact in case of an emergency.
Are you taking any prescription medications or have any serious medical issues we should know about? If yes, please specify. *
Do you have any mental, emotional, or physical issues that might have an impact on your participation? If so, please describe. *	Multi-day retreat involves an honest examination of the self through meditation and community practice which can, at times, be an intense experience. The following question is to help us ensure that you have a positive experience during your retreat and will be kept confidential. Please let us know, for example, if you have any previous hospitalizations; substance abuse history; obsessive compulsive disorders; etc. If you prefer, you can email Tergar Guide Tsunma Kunsang Palmo at kunsang@tergar.org to discuss this further.
Photo and Video Acknowledgment *	I understand that there may be video and still photography at this event. I will contact the event manager if I do not wish to have my image used.
Waiver of Liability	[en:]I understand I will be required to sign a waiver of liability in advance of attending this retreat.The waiver of liability will be shared with participants prior to the start of the retreat.
Email newsletter	Please send me the monthly Tergar Retreats newsletter. I understand I can unsubscribe at any time.
Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions.
Additional Comments *	Is there anything else we should know?

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Anytime Anywhere Meditation Retreat at Tergar Samadhi

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