Individual Registration

Suffering and Liberation in Relationships - An Insight Dialogue Retreat in the Heart of Winter

First Name *

Last Name *

Street Address *

City *

Zip *

Country *

Province *

Home Phone *

Cell Phone

Email *

Confirm Email *

Personal Information

This information helps us make your retreat experience as smooth as possible.

In-Person Retreat Covid-19 Safety *

I read and understand the In-Person Retreat Covid-19 Safety Measures.

Year of Birth (YYYY) *

Gender *

Male

Female

Transgender or gender diverse (e.g. gender fluid, gender queer, agender)

All accommodations are single rooms with locking doors. Bathroom blocks are located in each wing, and each toilet and shower stall is fully private and lockable. We cannot guarantee we can accommodate all wing preferences but we will do our best!

Preferred gender wing *

No preference

All-gender wing

Women’s wing

Men’s wing

Special Needs. All accommodations at Villa St-Martin are single rooms. Please indicate any special needs to assist in assigning your room.

Meals will be vegetarian with dairy and eggs. We cannot always accommodate special needs. If you have any special dietary needs for health reasons, please explain here.

Special Dietary Needs

Dairy Free

Gluten Free

Other

Please explain your special dietary needs

Residential Insight Meditation meditation retreat experience *

New to residential Insight Meditation retreat

I’ve attended 1-3 residential retreats

I’ve attended 4-10 residential retreats

I’ve attended 10+ residential retreats

Black, Indigenous and People of Colour

As part of TNI's commitment to diversity and equity, we have the intention to increase the participation of BIPOC participants in our retreats. To help bring this to fruition, we are holding a portion of all retreat spaces for BIPOC participants. Unused reserved spaces will be released one month prior to the start date of the retreat.

So we can support your participation in the retreat of your choice, please make us aware if you self-identify as Black, Indigenous, or a Person of Color *

Yes

Scholarships

Scholarships are awarded on the basis of financial need only and offer up to half off the base rate. Scholarships are awarded on a first come, first served basis. We are only able to offer partial scholarships, and must restrict scholarships to one per person, per year; only a limited number of scholarships are available for each retreat.

Would you like to apply for a scholarship for this retreat? *

Yes

Retreat Fees

Our retreat fees are on a sliding scale basis that allows participants to pay according to individual means. Fees do not include compensation for teachers, who rely on the generosity of retreatants for a sustainable income. There is an opportunity to offer dana (donations) to the teachers at the end of each retreat.

If you applied for a scholarship, please select the Base rate.

* Note that a minimum deposit payment of $315 is required to register for this retreat.

CANCELLATION FEES

If you cancel 4 or more weeks before a retreat begins, your deposit is refunded, less a $50 fee.
If you cancel less than 4 weeks before a retreat begins, your deposit is not refunded.

Payment

Please specify the payment method you wish to use *

Online with Paypal

Interac e-transfer

Check

Payment Information

Amount

Deposit Amount

Payment Type

Payment Method

Pay offline

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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