Have you attended a retreat before?
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Which retreat are you registering for?
Please select from the following...Foundations in Vipassana June 2019AoM Foundation September 2019Vipassana Retreat November 2019
How did you hear about Burgs and the Art of Meditation? If someone recommended us to you, please let us know who it was?
Please mention any previous meditation experience you have had with other teachers or other spiritual interests. Include dates and location where possible.
What is your reason for wanting to attend this retreat?
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Do you have any history of physical illness, operations, accidents, or suffer from any long-term degenerative disease? If so please give details with relevant timings.
Please name any medication that you are currently taking, or have taken in relation to this and when.
Do you have any history or diagnosis of emotional/mental health issues such as depression, anxiety, suicidal feelings or attempts, drug or alcohol abuse?If so, please provide some details. Please include information on any therapy you may have received/are currently receiving.
Please name any medication you are currently taking/have taken for this.
Normal VegetarianVegan/Gluten Free
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Preferred Room Type (Please note that single rooms are limited in availability and are generally prioritised for those with illness or elderly.)
Single Shd BathSingle Shd Bath (Supporter)Twin - Female Only
I agree that all the information I have provided is correct. I agree to abide by the Art of Meditation code of conduct whilst on retreat, and I take full responsibility for myself, and my actions for the duration thereof.
IMPORTANT: We cannot be held responsible for anything that may happen to you on retreat if you have not provided us with an honest appraisal of your current circumstances.
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