Silent Retreat Registration Form | Earth Horse Healing

Two-Day Silent Retreat
September 26-27, 2020
The Farm on Magnolia
Pemberton, New Jersey

The information you provide is held as private and will not be shared without your expressed permission. All fields marked with a red asterisk are required.

Name*
First Last
Phone*
Email*
Would you like to subscribe to the Earth Horse Healing email list?*
- Yes please
- No thanks
Address*
Street Address City State ZIP Code
Emergency Contact*
First Last
Emergency Contact Phone*
Emergency Contact Relationship to You

Spouse, partner, mother, brother, friend etc.
What is your experience with meditation?*
Meditation experience is not necessary for the retreat.
Please share a bit about yourself.*
Your passion and vision, your work professionally - what ever you'd like to say about you!
What would you like to learn or gain from this Silent Retreat?*
Please list any food allergies, sensitivities or dietary needs that we need to know about.*
I am 18 years of age or older*
- Yes
- No
You must be 18 or older to enroll in class.
Select payment method
- I'll mail a check for: $375
- Via PayPal, includes PayPal fee: $386.51
If you choose to pay by check, I'll send you the address to mail it to, thank you.
How did you first learn about Earth Horse Healing?*

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