Register for Bringing Mindful Speech to Life, 2018
E-mail address:
Name:
Phone:
Food preference:
vegetarian
omnivore
Please list any food allergies:
To help us assign rooms please check any that apply:
I have difficulty with stairs.
I snore.
Gender:
Female
Male
Other
Is there someone you want to room with?:
Please describe briefly any previous meditation experience:
Please list any previous NVC experience:
Are you willing and able to offer a ride to someone else coming from your area?:
yes
no
Please provide the name and phone number and relationship of someone to contact in case of emergency contact:
Payment method:
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Mailing Address: street
town, state & zip:
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