Registration Form
Print this page on your printer, fill it out, and mail in with your deposit.

Retreat/Class Name _______________________________________________________

Teacher Name ___________________________________________________________

Retreat/Class Dates _______________________________________________________


Your Name _____________________________________________________________

Address ________________________________________________________________

City/State/Zip ____________________________________________________________

Home Phone with area code _________________________ Work Phone _____________

E-mail Address _________________________________ Amount Enclosed ___________

For Retreats:

   Male ______ Female ______ 

   Please indicate special dietary or medical needs _________________________________
  ____________________________________________________________________
  (All meals are vegetarian, and may include eggs and dairy.)

For Retreats with Weekend Option:
           Week Long ______     Weekend Only ______ 

           Roommate preference for weekends only _______________________________________

Make checks payable to Tri-State Dharma. We regret that we cannot take credit cards at this time.

If you are signing up for more than one retreat/class, please make additional copies of this registration form so that we have a separate registration form for each event. Thanks.

Registration is required THREE WEEKS prior to the opening of retreats.
Registration for day long retreats and all classes can be up to the last minute, though advance registration, a week in advance, is preferred.  If there is less than the above stated time before the retreat or class, please call to see if there's still room.  

Deposits are not refundable, but can be applied toward another retreat if your cancellation is received two weeks prior to the event and the deposit is used within one calendar year.