Ayala Gill

Weeklong Retreat Registration Form - Sharpham House

Thank you for your interest in joining the retreat at Sharpham House/Moulin de Chaves.

Please complete this form and I will be in touch soon.

Name

Phone

Birthdate

Day

Month

Year

Gender

Please list previous yoga experience, if any, including style and how long you have practised.

Please list previous meditation experience, if any, including style and how long you have practised.

Have you attended a silent retreat before?

Do you have any physical, emotional or psychological conditions which may affect your participation in the retreat?

Are you currently using any prescribed medications for a mental health condition?

Why have you chosen to come on this retreat? What do you hope to receive?

Please state your room preference.*

Is there anything else you would like to share?

*See the list of rooms here. Note that rooms underlined are already taken