Teen Retreat (4 days) - TR

June 29 – July 3, 2014 (Sunday to Thursday)

Complete the information requested below, then click the "Submit Registration" button at the bottom of the form. Once your registration is submitted, you will receive a Confirmation Code — please quote this in any future correspondence. Within a week, you should receive further information from us regarding your registration status.

Retreatant Information

First Name
Last Name
Middle Initial
Email  
Address
City
Country
State/Prov
Zip/Postal Code
Day Phone
Evening Phone
Cell Phone

Retreat Fees

Sliding scale rate you select:
Sustaining $485.   (This represents IMS's actual cost for this program.)
Mid $405
Base $320
$170 Scholarship $145 Scholarship $125 Scholarship
  (Please select the highest rate you can reasonably afford. This allows us to better meet the growing number of requests for financial aid.)
 
Amount you will pay today:
Sustaining $485
Mid $405
Base $320
Deposit $320
Scholarship Deposit $125

Retreat Center Questions

Male Female  
 
Yes No
Yes No
Yes No
Yes No

Teen Retreat

Please note that we need you to submit a waiver signed by a parent or guardian before we can confirm you into this course:

Click here to download the waiver

 
 

Mailing Information

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
 

Financial Assistance Application

 
 
 
Yes No
Yes No
Yes No
Yes No

Payment Information

Note: Address below must match what is on file with your credit card company or the transaction will be declined.

 
Visa Mastercard

Additional Donation

I would like to contribute an additional amount to IMS.


I have read the registration information and cancellation policy. Click here to review.

Please submit your registration. Provided you have answered all the questions, a Confirmation Code should immediately appear on your screen. If no code number appears, your application did not go through. Please check that you have completed the form correctly and disabled all script blockers, and submit it again. If you have any questions, contact the Retreat Center by calling 978-355-4378 or emailing rc@dharma.org.



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