[AT HOME] Impermanence: A Vipassana and Metta Retreat (60 & over)

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1 Welcome

2 Fee Tiers

Please choose the option that best fits your ability to give in this time. Any amount paid above the Base rate is a tax deductible contribution to Southern Dharma Retreat Center.*

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Base

Select this option to pay the base rate for this program.

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$320

$320

$320
Base

Select this option to pay the base rate for this program.

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Supporter

Select this option to pay the Supporter rate for this program. The amount you pay above the base rate is...

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$460

$460

$460
Supporter

Select this option to pay the Supporter rate for this program. The amount you pay above the base rate is tax deductible.

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Subsidized

This is a reduced rate for those with more limited financial capacity.

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$180

$180

$180
Subsidized

This is a reduced rate for those with more limited financial capacity.

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3 Participant Info

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Will you be joining this retreat from a time zone 4 or more hours different from Southern Dharma’s time zone (Eastern)?	Yes No
Would you like to take advantage of our option to purchase video recordings for sessions that you are unable to attend due to your timezone?	Yes No A staff member will follow up with you via email regarding fees for recordings. No one will be turned away for lack of funds.
Email Newsletter	Please send monthly newsletter from Southern Dharma
Gender *
How do you identify your gender? *
What are your pronouns? *	She/her/hers They/them/theirs He/him/his Other
Please enter your pronouns.
Do you identify as LGBTQIA+ (lesbian, gay, bisexual, trans, queer, intersex, asexual, and beyond)? *
Do you identify as Black, Indigenous, or a Person of Color (BIPOC)? *	Yes No
How do you identify racially/ethnically?
Birth Date *
Emergency Contact Info (Name AND Phone Number) *
Is this your first meditation retreat? *	Yes No
Have you previously attended a retreat with Southern Dharma? *
I acknowledge that as a first time yogi at Southern Dharma, I must arrive by 5pm at the latest on the first day of retreat for mandatory orientation. *	I agree to arrive by 5pm on the first day of retreat and understand I will be turned away if I arrive after 5pm.
Individuals who volunteer to be the retreat Volunteer will be selected first off the wait list if a space becomes available. Are you interested in serving as a retreat volunteer for this program should one be needed? *	Visit the retreat volunteer page on our website for information about this position: https://southerndharma.org/retreatvolunteer/
Are you over 60 years old? *	This program is for retreatants 60 years old and older only. If you are under 60 you may not register for this program.
Are you applying for a Hemera Fellowship? *	Yes No Individuals are eligible for only one fellowship per calendar year. Hemera Fellowships cannot be combined with Southern Dharma scholarships.
If you have already been approved for a Hemera fellowship enter your scholarship code below. If you have not yet applied, WAIT to register, continue to https://hemera.slideroom.com/#/login/program/64702 to complete the Hemera application. DO NOT REGISTER until you receive your scholarship code. *	I understand that Hemera offers one fellowship award per applicant per calendar year. This is different from and cannot be combined with a Southern Dharma scholarship.Once your Hemera application has been processed and approved you will be given instructions to complete retreat registration at your approved fellowship rate.
Are you applying for a Southern Dharma scholarship? (BIPOC, Young Adult, or Need-Based) *	Yes No Individuals are eligible for only one Southern Dharma scholarship per calendar year. Only one scholarship can be requested per program and they cannot be combined with a Hemera Fellowship.
Have you already received a Southern Dharma scholarship for a retreat in 2024? *	Yes No
Individuals can only request Southern Dharma support for one retreat per year. Please note the Hemera Fellowship is a second funding option for those who qualify.	I understand.If you require further financial support in order to attend, please contact registrar@southerndharma.org.
Are you able to pay 50% of the Base Rate and still offer dana to the teacher(s) and/or the center? *	Yes No Retreat fees only cover a little more than half the cost to the center to offer a retreat, and teachers do not receive any compensation from retreat fees.
If you require further financial assistance in order to participate, please email registrar@southernadharma.org.	I understand.
Which scholarship are you applying for? *	BIPOC Young Adults Need-based Choose the scholarship that best fits your current situation. If you are not sure which to apply to or require more than 50% funding, email registrar@southerndharma.org for assistance.
Use the scholarship code BIPOC plus the 2-digit start month and 2-digit start date and 24 (no spaces) to complete your registration.	I understand that this scholarship does not cover voluntary dana offerings to the teacher and/or the Center.ex. BIPOC030324 for a retreat that begins on March 3rd, 2024. These scholarships are limited; if this scholarship code does not work then all available scholarships have been claimed for this retreat.
Use the scholarship code YOUNG plus the 2-digit start month and 2-digit start date and 24 (no spaces) to complete your registration.	I understand that this scholarship does not cover voluntary dana offerings to the teacher and/or the Center.ex. YOUNG030324 for a retreat that begins on March 3rd, 2024. These scholarships are limited; if this scholarship code does not work then all available scholarships have been claimed for this retreat.
Use the scholarship code NEED plus the 2-digit start month and 2-digit start date and 24 (no spaces) to complete your registration.	I understand that this scholarship does not cover voluntary dana offerings to the teacher and/or the Center.ex. NEED030324 for a retreat that begins on March 3rd, 2024. These scholarships are limited; if this scholarship code does not work then all available scholarships have been claimed for this retreat.
Scholarship Code (if applicable)	Select the Base Rate (from fee tiers, above), then enter your scholarship code.
I have read and agree to the terms of Southern Dharma's 2024 cancellation policy. *	I have read and agree to the terms of Southern Dharma's 2024 Cancellation Policy: https://southerndharma.org/cancellation-policy-2024/https://southerndharma.org/cancellation-policy-2024/

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1 Welcome

2 Fee Tiers

Please choose the option that best fits your ability to give in this time. Any amount paid above the Base rate is a tax deductible contribution to Southern Dharma Retreat Center.*

Base

Supporter

Subsidized

3 Participant Info

4 Payment