Last minute registration for Spirit Fire September 7 Day Silent Retreat Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *EmailConfirm EmailAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPhone number *How did you hear about this *Email from Kate Mitcheom Heart-Based MindfulnessEmail/website of CFM Oasis Institute Email/website of Spirit FireSaw on Kate's websiteFriend told meOtherPlease explain. Thank you!What drew you to this Retreat? (Check all that apply) *MindfulnessFulfill silent retreat requirementSpirit Fire LocationFriends are attendingOtherPlease explain. Thank you!Total Cost for September 2018 Retreat = $1650 for double occupancy and $2350 for single room. All rooms have shared bath. Sign me up!For Double Occupancy, shared bath ($1650)For Single Occupancy, shared bath (2350)PAYMENTS ARE NONREFUNDABLEI plan to pay by *Check (checks are preferred)Credit CardPayment information will appear when you select your option above. Your check for $1650 due immediately following registration. *I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.Please make out your $1650.00 check to Kate Mitcheom and mail to: Kate Mitcheom 17 Haycock Point Road East Branford, CT 06405 Your check for $2350 due immediately following registration. *I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.Please make out your $2350.00 check to Kate Mitcheom and mail to: Kate Mitcheom 17 Haycock Point Road East Branford, CT 06405 Pay $1650 by credit card *Price: $ 1,650.00You 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. Pay $2350 by credit card *Price: $ 2,350.00You 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. EmailSubmit