Test form 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 White Gate FarmSaw on Kate's websiteFriend told meOtherPlease explain. Thank you!What drew you to this Retreat? (Check all that apply) *MindfulnessFulfills 7 day Silent Retreat RequirementWhite Gate Farm LocationFriends are attendingOtherPlease explain. Thank you!Total Retreat Cost= $1650 for double occupancy, $850 for single room. Please register me for: Double Occupancy Room ($1650)Single Room ($1850)I plan to pay my deposit of $650 for double occupancy by: *Check (checks are preferred)Credit CardNon-refundable eposit of $650 is due with registration. Balance of $1000 is due by May 1, 2018. I plan to pay my deposit of $850 for a single room by: *Check (checks are preferred)Credit CardNon-refundable eposit of $850 is due with registration. Balance of $1000 is due by May 1, 2018. Your check for the deposit $650 due immediately following registration and remainder due May 1, 2018. *I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.Please make out your $650.00 check to Kate Mitcheom and mail to: Kate Mitcheom 17 Haycock Point Road East Branford, CT 06405 Your check for the deposit $850 due immediately following registration and remainder due May 1, 2018. (copy) *I understand that my space is not reserved until Kate Mitcheom receives my check at the address listed below.Please make out your $850.00 check to Kate Mitcheom and mail to: Kate Mitcheom 17 Haycock Point Road East Branford, CT 06405 Pay your deposit of $650 by credit card *Price: $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 your deposit of $850 by credit card. *Price: $850.00You 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. CommentSubmit