Future Retreat Registration

World Dharma Training Retreats ​International
Dates & Locations TBA
Online Request To Attend – Application Form
Wisdom of Mindfulness​ ​
Retreats with Alan Clements

​Space is limited to 25 participants at any World Dharma Retreat

Kindly fill out all fields in the application and we will get back to you in 1-3 days.

Sex?  Male Female

Full Name (First, Middle, Last)

 New Mexico Maui, Hawaii Costa Rica Portugal New Zealand Bali

Would you be willing to assist us in the organization of the retreat in the location you checked? If so, please let us know what you would like to do to assist, ie promotion, cook, admin, etc etc.

I would like to organize a World Dharma Retreat​ in a location not mentioned, above​? If yes, please let us know the location you had in mind: City, Region, Country.

Would you be willing to assist us in the organization of the retreat in the location you checked? If so, please let us know what you would like to do to assist, ie promotion, cook, admin, etc etc.

Have you organized a retreat before?
If so, please explain when, where, how long, what type of retreat and for whom.

Address

City

State/Provence/Territory

Country

Zip/ Postal:

Telephone (mobile) for texting:

Email

Website

Facebook

Skype contact

Best days and times to reach you:

Nationality:

Occupation

Emergency Contact Name, Relationship to You

Contact Address (City, State, ZIP & Country)

Emergency Contact Phone & Email

How did you learn of World Dharma and Alan Clements?

Please list ​any significant ​meditation​/dharma​ retreats you've attended. Include: Date, Teacher, Location, length.

If you have attended any previous retreats with Alan, please list them.

Please explain in a sentence or two why you want to attend this retreat.

What (if any) psychological and mental health issues have you had in your life, past or present?

Please list any medication you are currently taking for these issues.

Please list any dietary restrictions that are essential for you during the retreat.

Do you have any special needs or concerns that we should be aware of?

How will you pay for the retreat? Pay Pal? Credit Card? Check? Other?