Meditation Retreat Application

Name

First

Last

Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Age

Gender

How long have you been meditating?

How long can you sit in a meditation session?

Have you attended previous Sri Karunamayi retreats? If yes, on which dates?

Please indicate which Chakra Meditation Initiations you have received:

Your name as you wish it to appear on your name badge

Health & Emergency - Emergency Contact Name & Phone

Any medical condition we should be aware of?

Retreat Guidelines Acknowledgement* (Required checkbox)

I understand this is a silent meditation retreat. I agree to observe silence, follow ashram discipline, dress modestly, and refrain from photography and device use inside temple/retreat spaces.

I understand that maintaining a peaceful and respectful environment is essential to this retreat. In case of violation of retreat guidelines, or failure to follow ashram discipline, the organizers reserve the right to request me to leave the retreat premises, without refund or compensation.

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