2020 RETREAT REGISTRATION FORM Video Live Stream If you cannot attend the retreat in person, you may want to live stream the retreat. Click here for the live streaming registration page. Basic InformationYour name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone number*How did you hear about this retreat?Would you like to volunteer some of your time?YesNoWhen can you help out? I would like to volunteer before the retreat begins I would like to volunteer during the retreat Are you a Ren Xue teacher?NoYesWhich week(s) do you want to attend?*It is possible to register for online streaming for either or both weeks using our separate streaming registration form.BOTH weeks (4/18-4/30)ONLY Week 1 for Teachers (4/18-4/22)ONLY Week 2 for Everyone (4/22-4/30)Getting To Know YouAre you familiar with Yuan Gong?*YesNoYuan Gong methods*Please check which methods you are practicing, if any: Tian Yuan Di Yuan Ren Yuan Tong Yuan Ling Yuan None of the above (I'm new to Qigong) How many Ren Xue retreats have you attended?This will be my firstOneTwoThreeFourFiveSixSevenEightNineTen or moreHow often have you taught Ren Yuan in the last year?How often have you taught Tong Yuan in the last year?How often have you taught Tian Yuan and Di Yuan in the last year?How often have you practiced Yuan Ming Medicine in the last year?Are you reviewing the teacher manual sections on Ren Yuan and Tong Yuan?*YesNoAre you reviewing the teacher manual sections on the Theory of Consciousness?*YesNoIf you aren’t yet teaching or offering healings on a regular basis, would you like to be paired with an experienced teacher at the public retreat to gain experience?*YesNoHow comfortable are you offering REN XUE Guidance to public retreat participants?If needed, would you teach a method to a small group during the public retreat?*YesNoAccommodations & PaymentSelect your accommodations for April 22 - April 30Prices for accommodations will increase by $200 for registrations received after January 31, 2020. Notes: The single and double rooms have a shared bathroom. Both accommodations have limited availability and are offered on a first-come, first-served basis. Double rooms are for two, but the price is per person.$2,150: Double room$2,450: Single roomSelect your teacher accommodations for April 18 - April 22Prices for accommodations will increase by $200 for registrations received after January 31, 2020. Notes: The single and double rooms have a shared bathroom. Double rooms are for two, but the price is per person.$1,300 Double room$1,450 Single roomSelect your teacher accommodations for April 18 - April 30Prices for accommodations will increase by $200 for registrations received after January 31, 2020. Notes: The single and double rooms have a shared bathroom. Double rooms are for two, but the price is per person.$3,000: Double room$3,650: Single roomEarly registration discount Price: -$200.00 Your registration fee will be adjusted according to the following schedule. Complete ALL your payments by: • January 31, 2020 to qualify for a $200 discount DiscountsIf you have been given a discount code, please enter it below. If your code is valid, you will see the price reduction reflected below. Discount for code '2020LIGHT' Price: -$50.00 Discount for code '2020ENERGY' Price: -$250.00 Discount for code '2020BODY' Price: -$700.00 Discount for code '2020MIND' Price: -$1,100.00 Discount for code '2020EVERYWHERE' Price: -$500.00 Total registration fee Price: $0.00 How do you wish to make today's payment?Secure online payment using my credit cardI will mail in a checkI'd like to use PayPalCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Payment instructions Please make out your check to "Ren Xue of the Americas" and mail it along with a printout of the confirmation email you will receive from us to: Chris Dunaway 150 West Bissell Avenue Richmond, California, 94801 Emergency ContactWho should we contact in case you require emergency attention during the retreat?Name* First Last RelationshipPhone Number*Medical BackgroundRen Xue of the Americas will not share this information with anyone other than retreat staff and/or medical professionals called to assist with a health care emergency.Do you have any disabilities that might affect your ability to participate in the activities at the retreat?*YesNoPlease describe your physical challenges below.*Have you had, or do you now have, any psychological conditions that could affect the safety and wellbeing of yourself or others?*YesNoPlease supply some details about your psychological history below.*Do you have any medical conditions that would be helpful for us to know about?*YesNoPlease supply details regarding your medical condition(s) below.*Do you have any dietary restrictions?*YesNoPlease describe your food restrictions below.*NOTE: If you are taking prescription medications that we would need to know about in the event of a medical emergency, please bring a list to the retreat in a sealed envelope (with your name on the outside) for us to keep on file. It will be opened only in the case of an emergency and destroyed after the retreat. Certain medical (either physical or psychological) conditions may require that we speak with you before accepting your registration. If this pertains to you, we will contact you within three days of your registration, so please do not book travel arrangements until three days after you complete this registration form.Cancellation PolicyRen Xue of the Americas Retreat Cancellation/Refund policy for April 2019 Wonder Valley Retreat If you need to cancel your retreat registration, please do so early. Late cancellations make it difficult to give someone else the opportunity to attend. Once you have paid any portion of the retreat fee, administrative and possibly cancellation fees will apply, depending on the cancellation date. Policies will be applied in the same way for people attending full time and part time. If you cancel your reservation before March 1, 2019 at midnight we will refund all fees paid minus applicable administrative charges. If you cancel your reservation on March 2, 2019 or later, we will refund all fees paid minus $150 cancellation fee and applicable administrative charges. Refunds will be issued by check within 30 days of receiving cancellation notice. Anyone leaving the retreat early for a reason other than a qualifying emergency (medical emergency or a death in the family) will not receive any refund. If someone leaves early due to an emergency (as stated above), we will proportionately refund the days that are not attended minus the $150 cancellation fee and the applicable administrative charges. Ren Xue of the Americas reserves the right at any time to require that a participant leave the retreat if it is determined that the participant's behavior is either excessively disruptive or dangerous to self or others. In this case, all retreat fees are non-refundable. Cancellation by Ren Xue of the Americas In the highly unlikely event that Ren Xue of the Americas must cancel the retreat for unforeseen reasons, we will notify you as soon as possible and will refund the full fee amount paid including your deposit. Refund policy* I have read and agree to the above policy EmailThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.