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Insight Meditation Community of Charlottesville Retreat Registration Site
Teachers will be Sharon Beckman-Brindley, Hugh Byrne and Pat Coffey
Registration Form-IMCC Fall 2015 Retreat
Weekend Retreat: September 25-September 27
Weeklong Retreat: September 25-October 2, 2015
Registration closed for Fall retreat.
Please save the dates for our Spring 2016 Spring Retreat, May 13-20, 2016.
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
-
-
Email
*
Do you have any dietary restrictions?
Choose One
*
Yes
No
If yes, please describe:
*
Do you have physical limitations? (e.g., using stairs, walking, etc.)
Choose One
*
Yes
No
If yes, please describe:
*
Roommate preference?
List the names of people you would like to share a room with:
*
Gender Identity:
Room assignments are based on gender identity.
*
Snoring:
Are you willing to room with someone who snores?
Choose One
*
Yes
No
I snore?
Choose One
*
Yes
No
Registration Fee:
The actual weekly cost of the retreat per person is reflected below.
50% payment is due upon registration. The balance is due by September 1, 2015
.
Your registration is not complete until your 50% deposit has been received.
Room assignments are on a first come, first served, basis. Early registration assures best room assignment.
If you require financial support from IMCC please note it below. Single rooms are available only to those not requiring financial assistance. Rooms are assigned on a first come, first serve basis and assignments are dependent upon availability.
Weekend Retreat
*
Camping-$195.00
Shared Room, Shared Bath-$285.00
I want to apply for a scholarship
None-will attend weeklong
Weeklong Retreat
*
Camping-$675.00
Single room, shared bath-$1095.00
Shared room, shared bath-$990.00 (may be 2 or 4 to a room)
Queen bed, second queen or twin bed, private bath-$2000*
I want to apply for a scholarship**
None-will attend weekend
Shared room, shared bath may be 2 or 4 to a room depending upon availability.
Please indicate amount of scholarship requested:
*
*Cost is for the room. If 2 people share the room, the cost would be $1000 each plus $315 per extra person; if 3 people, the cost would be $667 each
plus $315 per extra person
.
**Scholarships are limited to one per year and for up to 50% of the retreat fee
Financial Aid Contribution:
As you know, expenses for retreats are increasing while personal incomes often are not. This means that some people who want to come to a IMCC retreat cannot afford the cost. It is our intention, when possible, not to turn anyone away for financial reasons. Scholarship contributions are all tax deductible. If you are making a donation with your application, we will provide you with a statement of your contribution upon request.
Donated funds will go into the IMCC Fred Meyer Scholarship Fund in order to assist those in need.
I would like to make a contribution in the amount of:
Choose One
*
$50
$100
$150
$200
Payment:
What method of payment would you like to use?
50% payment is due upon registration unless other arrangements have been made
.
Your registration is not complete until your 50% deposit has been received.
Choose One
*
Paypal
Check
If paying by Paypal, please click the red link which is the IMCC Paypal page:
PAYPAL
(Please note in Paypal comment box that the payment is for the Fall retreat)
If paying by check, please make it payable to "IMCC" and mail to: IMCC Retreat, 105 Monticello Ave, #402, Charlottesville, VA 22902
Requests for refunds will be considered before August 15, 2015. We are unable to offer refunds after August 15 due to fees that we must pay in advance to the retreat center. Refunds will be less a 15% cancellation fee.
Retreat fees cover the cost of room, board, and facility fees. No part of the fee covers payment to the teachers. Teachers are dependent on
dana,
which are contributions from those attending the retreat. You will have an opportunity to make a
dana
payment to the teachers at the end of the retreat.
Please direct any questions regarding the registration process or the retreat to: Jeffrey Fracher, IMCC President, at
[email protected]
.
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