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Retreat Registration Form
Contact Information
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Email
*
Verify Email
*
Phone
*
Select Retreat
*
select one
October weekend retreat (Oct. 14 to 16)
Fall MBSR Retreat (Nov. 5)
November weekend retreat (Nov. 11 to 12)
Rohatsu (Dec. 1 to 8)
Have you taken the MBSR course through Compassionate Ocean previously?
*
The MBSR retreat is open to graduates of past Compassionate Ocean MBSR courses.
select one
Yes
No
COVID-19 Protocols
*
The following guidelines will be in effect for people entering the Center: 1) Full COVID-19 vaccination (including booster) is strongly recommended. 2) Masks are required while inside the building. 3) Please do not visit if you are feeling ill. Please check the box below to acknowledge.
I have received and agree to the COVID guidelines.
Preferred payment method
*
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Check payment
Online payment
Donation
*
$
Add 3% to my total to cover payment processing fees (online payment only)
