TEST_Mystery Meditation

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1 Welcome

2 Price

3 Participant Info

Email newsletter	Please send me the email newsletter for Big Bear Retreat Center
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Phone *
How do you self-identify? Check all that apply	LGBTQIA+ Indigenous Black Latin(e/a/o) AAPI (asian american, pacific islander) White Adoptee Person with a disability Other As part of our ongoing commitment to DEIA (diversity, equity, inclusion, and accessibility) at Big Bear Retreat Center, we request that you share how you self-identify with us. This information is shared with the teaching team and informs future programming.
Please list the terms that best represents your personal identity *
Gender: how do you self-identify? *
Gender: How do you self-identify?
Pronouns (how do you self identify)?
Pronoun(s) *
Age *
Preferred Gender Room & Cabin Common Space *	All-gender is shared cabin that may include: women, men, non-binary, transgender, and gender-expansive guests. All-gender spaces are limited.
To accommodate everyone fully, if needed, would you be open to mixed gender lodging? *	Yes No
Please select all guest types that you would feel comfort sharing common space	Cis-men Cis-women Trans-men Trans-women Gender Non-Conforming Nonbinary All This will ensure all guests feel safe and welcome in their assigned spaces.
In the absence of All-Gender accommodations, do you have a binary preference for lodging?	Space in all-gender cabins is limited and prioritized for our gender expansive friends. If you have one, please list a binary preference in the event the all-gender cabins are full.
Do you use a medical device that needs an outlet? *	Yes No ie CPAP machine, Insulin pump, pacemaker
Please specify
Please list any special accommodations for lodging and/or mobility
Are you requesting to share a room/cabin with someone you know? *	Yes No Sharing a room with a familiar person is generally discouraged on Insight Silent Retreats. All requests must have prior approval from the teachers regardless of retreat type.
If yes, please provide more context so we may submit your room share request	Please include the name of the person you wish to share a room and a brief reason why the request is being made. All requests must be approved by the teachers.
Do you have any dietary restrictions? *
Please list any severe food allergies. This section should not include food preferences or dislikes.	All meals are served buffet-style with clearly labeled ingredients. There are plenty of alternatives if you need to choose to avoid certain items. Please reserve this section for medical allergies only.
Allergies: Select all that apply.	Peanuts Dairy Wheat/Gluten Tree Nuts Eggs Sesame Soy Other
Please list other severe allergies
Thanks for letting us know about your allergy. Which diet best aligns with your needs. *	To help us prepare, please choose the dietary profile that best reflects what you'll be enjoying from our buffet.
Please indicate your experience with Vipassana (Insight) silent residential retreats *
Have you practiced with these teachers before? *	Yes No
Have you ever attended a retreat in-person at Big Bear Retreat Center? *	Yes No Online only with BBRC
How many other retreats at Big Bear Retreat Center have you attended? *
Where did you find out about this program? *	Email or newsletter subscription A teacher Print/Web Ad Social media A friend Website An invitational Our Weekly Online Lunchtime Mindfulness Other
Which email/newsletter subscription?	Big Bear Retreat Center newsletter Insight LA newsletter Other newsletter/email source
Which teacher?
Which ad?	Lions Roar Magazine Mindful.com Other
Please specify here:
Which social media platform?	Facebook Instagram YouTube LinkedIn Other
What is your friend's name?
Which website?	Big Bear Retreat Center Insight LA Other

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4 Agreement and Policies

Attendee of this retreat is 18 years of age or older *	Yes, attendee is 18 years or older No, attendee is under 18 years of age
If attendee is under the age of 18 *	A spot is not guaranteed for minors. Approval is considered by the teaching team and BBRC staff. Please contact guestservices@bigbearretreatcenter.org.
I understand that I am expected to arrive at the designated arrival time on opening day and participate for the full duration of the retreat. *	I understandExceptions are made for medical, family, and other emergencies. All other late arrivals or early departures require prior approval from the teaching team.
By signing up you agree to our cancellation policy *	I have read and understand the BBRC cancellation policyPlease read and review Cancellation Policy.
I have read and agree to all BBRC Waiver and Release, terms and community agreements *	IMPORTANT: I am aware that this is a release of liability and a binding contract between myself and Big Bear Retreat Center. I have read the above agreement, fully understand its contents, and voluntarily agree to be bound by its terms.Please read and review: Terms and Community Agreements.
I agree to uphold the commitment of noble silence (as directed by the teachers) and to participate fully in this retreat, without leaving retreat center (except in the case of emergencies or medical needs) *	I understand and agreeSilence and renunciation are at the heart of Insight retreats, and many others, and a sincere commitment to honoring them has a direct and profound bearing on our deepening in meditation. We request that all guests honor the vow of noble silence if instructed by your retreat teachers and that you agree to silence throughout the retreat in the entirety of the retreat center. Please notify our Office if arrangements need to be made for messages to reach you from family members.
I am willing to undertake the practice of refraining from using electronic devices while on retreat, as instructed by the teacher(s). *	I understand and agreeWe request and encourage refraining from cell phones and other communications, as instructed by your teachers. At orientation we will share the best method of communication with BBRC staff and teachers during retreat.
Photography Release *	I grant permission I do NOT grant permission I hereby grant permission to Bear Retreat Center to use photographs and/or video of me and/or my guests taken during my stay in publications, news releases, online, and in other communications related to the mission of Big Bear Retreat Center. Please contact us if you have any questions, concerns or special requests related to this.

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5 Donate

$	(optional) Dana / Donation to BBRC's Scholarship & Accessibility Fund For those able to offer more, your donation goes directly to our special funding and scholarships to help make these offerings accessible to as many people as possible. Please consider paying at the highest-level you can comfortably afford.

6 Security Check

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7 Payment

Scholarship / Discount Code	Please provide the scholarship code provided by the registrar. InsightLA coupons will not work in this box. If registering with an InsightLA coupon or credit, please contact guestservices@bigbearretreatcenter.org and we will help get you sorted.

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1 Welcome

2 Price

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3 Participant Info

4 Agreement and Policies

5 Donate

6 Security Check

7 Payment

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