Mindfulness Meditation Retreat in Cuba with Hugh Byrne & Rebecca Hines
We are glad you are interested in joining us on our retreat in Cuba, January 20-27, 2018. To begin the registration process, please tell us about yourself:
 
1.
The basics:

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

Your gender: 

 

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3.

Your birthday: 

 

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4.
Do you identify as a person of color?
 

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5.
Do you identify as LGBTQ?
 

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6.

Is this your first silent meditation retreat?  

yes
no
7.

Briefly describe your meditation experience:  


 

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8.

Is there anything else you would like us to know about yourself or your interest in this retreat?  

 

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