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Application Form

IMOKO  RETREAT

Son Retreat with Jisu Sunim

Dates: to be announced

 

 

 Please fill in this form (click here for printable version) & return it with your deposit of £100. The balance of £250 is payable by 27th July 2011.

 Personal information given will be treated in confidence. Cheques should be made out to : D.W. Reiter We will always attempt to re-fill any cancelled place, in which case we will offer a refund.

 

Surname:

First Name:

 

Address:

 

 

 

Post Code:

 

Telephone:

Mobile:

Email:

Gender:

Date of Birth:

 

Previous Retreat experience:

 

 

 

 

 

Special Diet / Needs:

 

 

Do you suffer from any physical/mental health problems:

 

 

 

 

Do you need or can you offer a lift to the venue:

 

 

 

Please note that refunds will only be available if we can reallocate the cancelled booking or if the event is cancelled. Please return completed forms to:

 

Ned Reiter

Son Retreat

13 Bere Lane

Glastonbury

SOMERSET BA6 8BD