*** Please print out this form for you to complete. ***

SACRED MEDICINE JOURNEY
IRELAND

2017 Retreat Registration Form


I am registering for:

______ September 1st - September 10th 2017 Retreat



NAME:
_________________________________________

ADDRESS:
_________________________________________

_________________________________________

_________________________________________

PHONE:
_________________________________________

CELL:
_________________________________________

EMAIL:
_________________________________________


DIETARY NEEDS OR HEALTH ISSUES:

_________________________________________

TOTAL INTENDED LENGTH OF STAY IN IRELAND:

*** For people choosing to stay in Ireland before or after the the course.

___________________________



TOTAL INTENDED PAYMENT: ________________


PAYMENT SENT UPON REGISTRATION: ________________

PLEASE CHECK THOSE THAT APPLY:

( ) I am sending my payment in full.


Sliding Scale from $1475 - $1575 in US Dollars
(Honour system based on income level)


( ) I have sent my deposit of $350 to hold my space. (non-refundable)

The $350 deposit is part of your tuition, and should be subtracted from your total payment.


( ) I have sent my deposit of $_______ plus $_______ of my payment.


*** Must initial to complete registration:


* Make checks payable to The Gaia School of Healing.

* Send completed retreat registration form and payments to:
The Gaia School of Healing, c/o Sage L. Maurer, 172 Pine Banks Rd., Putney, VT 05346

Contact by phone or email: 617-838-8094, thegaiaschool@gmail.com





Please feel free to contact Sage with any questions, at thegaiaschoolca@gmail.com, or call 617-838-8094.



Please take the time to answer the questions below so that we can learn more about you.


How did you find out about the Ireland Sacred Medicine Journey?


What are your specific interests regarding plants, healing, and spiritual practice?



What are you most looking forward to learning and experiencing during this course? What are your desires and expectations?








Do you have any questions about the course or your stay at Boghill Centre and Crann Og Eco Farm that you would like answered?










Please take some time to tell Sage about yourself, and to ask her any questions that you have regarding this retreat. If you have any special needs or concerns, please voice them so that we can try to address them well before the start of the retreat.












We look forward to you joining us!
Green Blessings, The Gaia School

The Gaia School of Healing & Earth Education
c/o Sage L. Maurer
172 Pine Banks Rd.
Putney, VT 05346

thegaiaschool@gmail.com
617-838-8094