City & State
How do you describe your ethnicity, race or cultural background?
How do you self-identify your sexual orientation?
Name/phone # of someone we can contact in an emergency who will be available by telephone during this retreat?
Name of organization you are affiliated to, and length of time working full time as an animal rights advocate?
How did you hear about this retreat?
Section 2: Meditation and Retreat Experience
Indicate your experience with Meditation RESIDENTIAL retreats and the form you have practiced in (i.e. Vipassana, Zen, Dzogchen, Other Tibetan Practices, Kriya Yoga etc.)
New to Meditation Residential Retreat practice
1-3 Residential Meditation Retreats
4-10 Residential Meditation Retreats
10+ Residential Meditation Retreats
List dates (year) and length of previous RESIDENTIAL Meditation retreats, along with the name of Teacher, type of practice, and name of Center/Monastery, or indicate N/A if not applicable.
Eg: In July 2014, I attended a 10-day Residential Meditation Retreat with Joseph Goldstein. Type of Practice was Vipassana (or Insight) at Spirit Rock Meditation Center
List the form of meditation practices or spiritual traditions that you have been or are currently involved with (i.e. Vipassana, Zen, Dzogchen, Other Tibetan Practices, Kriya Yoga etc.) and the approximate number of years you have practiced in this or these traditions, or indicate N/A.
What is your current daily/weekly spiritual/meditation practice or indicate N/A?
What kind of blocks or challenges do you experience in your current spiritual practice?
Section 3: Reflective Questions
What motivates you to attend a meditation retreat at this time?
What role does inner reflection (or inner inquiry or any contemplative practices such as meditation) play in your life as an activist?
What do you imagine you will receive from this retreat, that you feel will be supportive or nourishing for you?
Do you have any history of physical or psychological conditions that may interfere with or might be aggravated by sitting or walking meditation practice?
(Yes/No) If yes, please describe. Please note that your stating 'yes' will not limit your participation. We wish to do our best to welcome people from diverse abilities and experiences at this retreat. Your answer simply helps us plan better so that we can offer the resources and facilities that will support you.
Any additional comments or information you would like to convey to the teachers?
Thank you! You will hear back from us very soon.
Please note that we are over subscribed. We are doing our best to accommodate everyone by requesting more rooms at the retreat center. But there is a possibility that you may be put in the waitlist - especially if you cannot attend the entire retreat.