Registration form Yamantaka summer retreat 2023 Name * E-mail * Adress Postal code City Telephone number * In case of calamities we want to be able to reach you Contribution: For a short retreat (5 to 10 August): $ 75.00 / For a long retreat (5 to 19 August) $ 180,- * $ 75,- $ 180,- I'd like assistance in finding a place to stay * Yes No I am a Jewel Heart member * Yes No Solidarity fund Jewel Heart has a solidarity fund for people who would like to attend classes, but cannot (fully) afford this financially. If you want to appeal to the solidarity fund, please contact the secretariat (info@jewelheart.nl). If you want to contribute to this solidarity fund, you can indicate here what amount. Total contribution * I will transfer the total amount (add up yourself) to BIC: INGBNL2AXXX IBAN: NL95 INGB 0005 7122 89 in the name of. Jewel Heart Nijmegen, stating: "Yamantaka Retreat 2023". Remarks Any comments or special wishes? Send
