Essentials of Mindfulness: Silent Retreat January 2018 Registration Read full details of Retreat. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *EmailConfirm EmailAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone number *How did you hear about this *Email from Kate Mitcheom Heart-Based MindfulnessEmail/website of CFM Oasis InstituteEmail/website of Spirit FireSaw on Kate's websiteFriend told meOtherPlease explain. Thank you!What drew you to this Retreat? (Check all that apply) *MindfulnessFulfill 5 day silent retreat requirementSpirit Fire LocationFriends are attendingOtherPlease explain. Thank you!Total Retreat Cost= $1450. I plan to pay my deposit of $700 by *Check (checks are preferred)Credit CardNon-refundable eposit of $700 is due with registration. Balance of $750 is due by January 5th, 2018. Your check for the deposit $700 due immediately following registration and remainder due January 5, 2018. *I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.Please make out your $700.00 check to Kate Mitcheom and mail to: Kate Mitcheom 17 Haycock Point Road East Branford, CT 06405 Pay your deposit of $700 by credit card *Price: $700.00You will be sent to Paypal to complete your purchase. You may choose "Pay with debit or credit card" and check out as Guest, if you wish. No need to have a PayPal account. NameSubmit