JOIN US FOR YUAN TZE'S NEXT IN-PERSON RETREAT REGISTRATION FOR ACCOMMODATION AND MEALS April 13-21 at Wonder Valley Ranch, California USA Registration Form 2024 - Accommodation and Meals "*" indicates required fields Basic InformationAre you a Ren Xue teacher? No Yes Your name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone number*How did you hear about this retreat?*Our websiteRen Xue TeacherNewsletterWord of mouthFacebookInstagramGoogle searchI've attended previous retreatsOtherOther: Would you like to volunteer some of your time? Yes No When can you help out? I would like to volunteer before the retreat begins I would like to volunteer during the retreat Getting To Know YouAre you familiar with Yuan Qigong?* Yes No Which Yuan Gong methods are you familiar with?* Tian Yuan - 1st method Di Yuan - 2nd method Ren Yuan - 3rd method Xia Yuan - 4th method Zhong Yuan - 5th method Shang Yuan - 6th method Tong Yuan - 7th method Ling Yuan - 8th method Ming Yuan - 9th method Select AllIn which region(s) have you attended a Yuan Tze-lead Ren Xue retreat? France Ireland New Zealand Sweden United Kingdom USA Other How many Ren Xue retreats have you attended?This will be my firstOneTwoThreeFourFiveSixSevenEightNineTen or morePlease help us verify our data by confirming the levels you are qualified to teach. All levels 1-6 Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 (You may check as many as apply.)If you aren’t yet teaching or offering healings on a regular basis, would you like to be paired with an experienced teacher at the retreat to gain experience?* Yes No How comfortable are you offering REN XUE Guidance to retreat participants?*Very uncomfortableUncomfortableAmbivalentComfortableVery comfortableIf needed, would you teach a method to a small group during the retreat?* Yes No Accommodations & PaymentSelect your accommodations Accommodation and Meals for $1,750.00 How do you wish to make today's payment? Secure online payment using my credit card I'd like to use PayPal Credit Card Emergency ContactWho should we contact in case you require emergency attention during the retreat?Name* First Last Relationship Phone 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?* Yes No Please describe your physical challenges below.*Do you have any medical or psychological conditions that would be helpful for us to know about?* Yes No Please supply details regarding your medical condition(s) below.*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 conditions (either physical or psychological) may require that we speak with you before accepting your registration. If we need to speak with you, we will contact you by email within 5 days of receiving your registration form. Do you have any dietary restrictions?* Yes No Please 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 2024 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 15, 2024 at midnight we will refund all fees paid minus applicable administrative charges. If you cancel your reservation on March 16, 2024 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 Informed consent agreement* I am aware that REN XUE was designed to be a safe, effective and efficient alternative modality for health and wellbeing, but it also has its limitations. To my best knowledge, I have no medical or psychological condition that would prevent me from taking part in this REN XUE activity, and I assume all responsibility for my participation. I understand that REN XUE and Yuan Qigong are not a substitute for medical attention, examination, diagnosis, or treatment. I have read, fully understand, and agree to the terms of this Informed Consent Agreement and Supporting Information. I indemnify and release Ren Xue of the Americas, Yuan Tze, and all people operating on their behalf, from all liability for personal damage or injury to myself. I am signing this agreement voluntarily and recognize that acceptance of these terms serves as complete and unconditional release of all liability to the greatest extent allowed by law. NameThis field is for validation purposes and should be left unchanged. Δ
