Retreat registration form

The Quest Countryside Escape - 2014

Personal details
Name*
First Last
Address*
Street Address City ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone
Date of birth*
Month
Day
Year
How would you describe your ethnicity?
In case of emergency
Please provide the name and contact number of someone close to you in case of emergency during the workshop.
Name
Phone
Contact's relationship with you:
Reservation and Room Selection
To reserve your place, please make your selection below.
Please choose:*
Bursary information
If you would like to apply apply for a bursary please fill in the field below and we will send you further information.
Please give reasons why you need to apply for a bursary
Donation
If everyone who could afford to do so made a small donation to the Bursary Fund, we'd be able to help a lot more people with low incomes participate in The Quest events.
Would you be able to make a donation to the Bursay Fund?:*
- Yes
- No
Please choose an amount to donate
Other amount
Total
£ 0.00
(When you submit this form you will be forwarded to a secure Paypal page for payment).
About you and The Quest
Is this is your first time attending an event organised by The Quest?*
- Yes
- No
How did you first find out about The Quest?
Health and dietary requirements
Are there any health concerns, disability issues or needs (physical or psychological) that it would be helpful for us to be aware of, to help you get the most from the week?:
The event is full-board, with vegetarian food. Do you have any special dietary needs?:
- No wheat
- No dairy
- No wheat or dairy
- Vegan
- Nut or other allergies
- Sugar-free / diabetic
- Other
Other dietary requirements
Terms and Conditions
Please tick here to proceed*
- I accept the terms and conditions stipulated below
The Quest team asks you to:
- * Be responsible for your own safety and exercise due care for yourself throughout the retreat
- * Be respectful towards others and of their personal boundaries
- * Take care of the venue and equipment, and respect the boundaries of Dunford House

Δ

Transformational spaces that explore + cultivate wholehearted living

Twitter Youtube Facebook Instagram

Be the first to know

Subscribe to receive updates about our events and programs

First Name

Last Name

Email

Sitemap

Retreat registration form

The Quest Countryside Escape - 2014

Personal details

In case of emergency

Reservation and Room Selection

Bursary information

Donation

About you and The Quest

Health and dietary requirements

Terms and Conditions