Registration Form: Meditation Retreat for Animal Rights Activists by The Pollination Project

Important: The following questions are purely for the purpose of supporting practice during the retreat. Your answers will remain confidential and only available to the teachers and organizers of this retreat.
We are asking questions around race, sexual orientation, age, etc. because we hold a sincere intention to create greater inclusivity, diversity and safety for all participants in the retreat,  and make this retreat welcoming and supportive for people coming from varied backgrounds.


Name *
Phone *
Eg: He, She, They, Ze or Other
(Yes/No); If Y, please elaborate:
(Yes/No); If No, what is your primary language?
Section 2: Meditation and Retreat Experience
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
Section 3: Reflective Questions
(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.
(Yes/No); If No, please mention dates. For example: I will attend from 5pm on May 26th to 12pm on May 29th.