Six-day Retreat

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1 Registration

2 Accommodation

Select an option*

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Female Single Room

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AUD $670

AUD $670

AUD $670
Female Single Room

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Male Single Room

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AUD $670

AUD $670

AUD $670
Male Single Room

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Single Room (Any Gender)

If male or female, please only choose this option if male/female rooms are full.

More Details +

AUD $670

AUD $670

AUD $670
Single Room (Any Gender)

If male or female, please only choose this option if male/female rooms are full.

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Concession discount available upon registration for people who are unable to afford the full price.

If your room option is FULL, please Join Waitlist

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3 Participant Info

Phone *	Phone or Mobile Number
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Gender *
Year of birth *

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4 General information

Have you previously sat a retreat at BMIMC *	Yes No
BMIMC newsletters	I would like to receive BMIMC updates and newsletters
Teacher schedule	I would like to receive updates from the teacher of this retreat about their schedule outside of BMIMC
How will you be travelling to BMIMC? *
Car rego number (if driving):
Special Diet	Special meal requestedAll of our food is vegetarian and generally gluten free. We are not usually able to cater for alternate dietary needs except for a 'special diet' alternative, which is a meal of steamed vegetables, tofu & brown rice provided as an addition to food on the main table. There is a fridge & microwave available for yogi use, but no access to cooking facilities. If you need to discuss dietary concerns further, please contact our office.

5 Information for the teacher

Have you previously sat a meditation retreat of nine days or longer? *
What is your meditation experience, and within what meditation traditions? *	List details of your practice including any retreats, to the best of your ability. Please include YEAR \| NUMBER OF DAYS \| TRADITION \| TEACHER NAME. We do not need a comprehensive list of every retreat you have done, but teachers need as much information as possible so they can best support your practice.
Describe any present circumstances that might place your meditation practice under additional stress (e.g., recent loss of a loved one, job loss, substance abuse, physical or pychological problems). *
Have you been diagnosed with a psychological or physical condition or illness? If so, please describe the diagnosis, treatment and dates. *
Are you taking prescription medication of any kind? If so, please give details. *
Are you currently seeing a psychiatrist, psychologist, psychotherapist or counsellor? *
If so, do you give BMIMC permission to contact your therapist in an emergency?
Therapist's name
Therapist's phone no.

6 Emergency contact information

Emergency contact name *
Emergency contact phone *
Emergency contact relationship *
Comments

7 Retreat Agreement

I agree to arrive on time and stay to the end of the retreat, unless there is an emergency *
I agree to hand in my phone to the office or keep it switched off for the duration of the retreat, unless there is an emergency *
Guidelines and Policies	Guidelines and policies for the centre are outlined in the About retreats at BMIMC (FAQ) section of our website.

8 Concession discount

9 Payment Details

Discount code	To get the 30% discount enter the code CONCESSION then Apply.

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Six-day Retreat

1 Registration

2 Accommodation

Select an option*

Female Single Room

Male Single Room

Single Room (Any Gender)

3 Participant Info

4 General information

5 Information for the teacher

6 Emergency contact information

7 Retreat Agreement

8 Concession discount

9 Payment Details