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Registration Form

Name:

Email: (required)

Phone: (required)

Cell: (required)

Address:

Registering for: (Course name, required)

Arriving in Ireland:
from:

to:

Contact in Ireland: (if applicable)

Food Restrictions:

(note that if there are severe restrictions you may need to bring supplies - please take care of your health and comfort)

Physical limitations:

(note that Lios Dana is not wheelchair friendly, again please take care of your health and comfort)

How did you hear about us?

After you fill in and send the registration form, you can also pay for the course with the form below:

When you are at the paypal page, update the Unit Price box with the amount you want to pay and then click “Update Totals”

Form of Payment
Course name and dates
Amount sent

 

 

Retreat ~ (verb) the act of withdrawing in order to gain strength and information so that you can move forward productively. (noun) A safe sanctuary where one can retreat (see verb above)

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Lios Dana

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