Registration

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Preferred way to contact you

Email

Email + Phone

Phone

Date of birth

MM

DD

YYYY

Preferences

Single Room

Double Room

Are you coming to retreat with your friend who would be sharing your room?

Yes

No

Would you like a bedroom with a futon or bed?

Futon

Bed

Would you like a fish or meat lunch at Uonuma No Sato?

Fish

Meat

Booking and Cancellation Policy *

50 % deposit is required at the time of booking and the balance is due 3/15/20. Because of the required upfront costs and logistics involved retreat is not refundable. We highly recommend purchasing the travel insurance in the event of unforeseen situations such as natural disasters, personal conflicting events, etc… We accept transfer of registration from one person to the other if you are able to find someone who can take your space.

I agree

Waivers and Releases *

Link to Waiver

I Agree

Terms and conditions * *

Link to terms and conditions

I agree

Privacy Policy *

Link to Privacy Policy

I agree