Registration Form

Dancing in the River of Life: Meditating with Interconnectedness Through the Five Elements (Residential Only)

October 8 - 14, 2024

- With Lama Liz Monson and Matthew Bellows

* These fields are required

People in your group

Guest 1		First Name* Last Name* Email* Gender identification*
Guest 1		First Name* Last Name* Email* Gender identification*

After completing this form, emails will be sent to everyone in your group to complete their information.

Optional Items

Bedding for selected room type (only available if you are flying in)

$10.00

Select quantity

Bath Towel (only available if you are flying in)

$5.00

Select quantity

Pick-up from New London Bus-stop (from Boston area)

$15.00

Select quantity

Drop-off at New London Bus stop

$15.00

Select quantity

Pick-up from Lebanon Bus stop (from New York area)

$30.00

Select quantity

Drop off at Lebanon Bus Stop

$30.00

Tell us about yourself

First Name *
Last Name *
Email *	IMPORTANT. PLEASE READ. When registering for events, please be sure the email address you use to register is the SAME email address you use to log into your user account. Recordings and course materials are connected using the event registration list. To prevent duplication and scattering of your resources, these two addresses must match.
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Phone No. *
Gender identification *	We recognize that these two choices are not the only way people identify themselves. Our registration program uses this field to automatically assign rooms and does not assign people of different gender identities to shared lodging unless specifically requested. If you identify as non-binary, please make the selection you are most comfortable with.
What pronouns do you use?
SHARED ROOM ONLY: I understand that I may be sharing a room with someone I do not know.
If I am sharing a room, I wish the following person to be my roommate if possible:
Emergency Contact (Name, Relationship & Phone) *	Please list someone who is not at the retreat.
Waiver of Liability *	Understanding the voluntary nature of my participation in the work, programs, and activities offered through Natural Dharma Fellowship (NDF), and in return for the benefits I receive from them, I release and discharge NDF and its agents and employees, and I promise to hold NDF and its agents and employees harmless, from all causes of action, liability and claims for all personal injuries, illness, property damage or death which I may now or hereafter have, which are caused by, or are directly or indirectly related to, any work I may perform or any activities in which I engage during my participation in this NDF program or my stay at the center. For the period of this class, by checking this box, I agree that I am covered for my medical insurance and these areas are not the responsibility of Natural Dharma Fellowship. I agree to accept full responsibility for the security of my personal belongings. Wonderwell is not responsible for lost, missing, or stolen items.
Do you have any food allergies?	If you are allergic to more than one food item, please indicate the severity of others in the comment box just below. Please check in with the kitchen staff after you arrive.
Please indicate the severity of your allergy to this food item or ingredient	I cannot ingest the allergen I cannot ingest food that has come in contact with the allergen I cannot come into skin contact with the allergen I cannot be exposed to airborne particle of the allergen
Other dietary restrictions (all of our meals are vegetarian)	Vegan Dairy Free Gluten Free Other (indicate in Comment box below)
Comments on food allergies and dietary restrictions
Do you have any problem stepping into a tub shower?	Yes No Several of our rooms have tub showers. While we cannot guarantee availability of rooms with step-in showers, if you have any problem stepping into a tub shower, we will do our best to place you accordingly.
Comments or Special Needs
I understand that this retreat involves some vigorous activity, including hikes of 4 to 5 miles.
Program Participation Agreement & Release *	I agree to these terms and conditionsWhile in retreat here at Wonderwell, we ask all guests to strictly adhere to the 5 precepts during a retreat program: 1) refraining from lying or gossiping, 2) refrain from taking what is not given, 3) no sexual misconduct, 4) not causing harm to others, and 5) no consumption of drugs or alcohol. Violation of these precepts will be grounds for dismissal. If you are having difficulties that may lead you in one of these directions, please contact a Teacher or the Retreat Manager. Need to Self-Monitor Food Allergies: I understand that I am responsible for knowing whether any ingredients to which I am allergic exist in any foods that are prepared by Wonderwell. If I am uncertain about the ingredients of these foods, I am responsible for obtaining that information from the cooks who have prepared or overseen the preparation of such food. Recordings, Photographs and Social Media: Retreats and other events at Wonderwell are frequently photographed, recorded, and broadcast online. I hereby consent to being included in any photographs, recordings and broadcasts that may occur, and I grant permission for these to be used by Wonderwell and Natural Dharma Fellowship for educational and promotional purposes. In order to protect the privacy of others, I agree not to publish any photographs, video or audio recordings of other individuals, or make use of the Wonderwell name or logo, without express permission. I understand that I am solely responsible and potentially liable for any harm or damages caused by my online activity relating to Wonderwell.
Cancellation Policy *	I understand and accept the cancellation policyWonderwell charges a $75 cancellation fee for residential (onsite) retreat cancellations more than 4 weeks before the start of a retreat. Any cancellations between 4 weeks to 11 days prior to the program are charged a $150 cancellation fee. For any cancellations 10 or fewer days prior to the start date of the program, no refunds are offered. However, if you are feeling ill or have been exposed to the COVID virus, please cancel your attendance at any Wonderwell retreat even at the last minute. In this case, we will provide a full refund of your payment. If you decide to transfer from residential to online attendance, any cancellation fee will be determined based on the time remaining before the start of the retreat.
Is this your first time attending a Natural Dharma Fellowship event? *	Yes No
How did you hear about this event?
If you selected Other, please specify how you heard about the event
Email newsletter	Please add my name to the Natural Dharma Fellowship e-newsletter distribution list

Payment

All payments are processed and secured by Paypal Pro. We do not accept American Express cards.

If you choose to pay a deposit, please keep in mind that Wonderwell will automatically charge this credit card with any remaining balance 30 days before the retreat begins.

Sub Total	$0

Taxes	$0

25% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Choose Payment Option

	Paying with credit card is Wonderwell's preferred payment method. However, if you need to pay with check, please know your check must be received within 7 days from submitting this registration, or the registration will be cancelled. Payable to: Natural Dharma Fellowship PO Box 324 Springfield, NH 03284 Click on the button below and these instructions will be repeated on the next page.

First Name
Last Name
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card

Dancing in the River of Life: Meditating with Interconnectedness Through the Five Elements (Residential Only)

Price

Select an option*

Suite/Benefactor

Private Room w/Queen Bed & Ensuite Bath

Private Room w/Queen Bed & Hall Bath

Private Room w/Twin Bed & Hall Bath

Shared Room w/Ensuite Bath

Shared Room w/Hall Bath

Men's Dorm

Women's Dorm

Camping/Tent or Vehicle

Camping/Self-Contained Vehicle

As Commuter

People in your group

Optional Items

Tell us about yourself

Payment