First name *

Middle name

Last name *

M    F    other

company name (in case you want this on your invoice)

Address *

Zip code *

City *

Country *

Phone number *

email *

Date of birth (DD-MM-YYYY) *

Meditation: please describe your meditation experience (tradition, practice, duration, number of years) *

Yoga: please describe your yoga experience (tradition, practice, duration, number of years, training – if applicable) *

Retreat experience: please describe your retreat experience (tradition, teachers, duration, number of retreats/years) *

Please describe your experience with teaching mindfulness, or applying mindfulness practices in your work: *
yes no

Mindfulness teacher training: please describe the teacher training program(s) you have completed *

How did you hear about this program? *

Is there any other information you would like to share with the teacher(s)?

Who may we reach in case of emergency? Please list phone number, name and relationship. *

Food needs: dairy-free, nut-free, glutenfree

Do you currently experience major health issues? If yes, please describe. Do you suffer from serious psychological problems, such as addictions, anxiety, depression? Are you currently in therapy? Do you take any medicine for your mental health? Please describe here. * * Please note: answering "yes" to this question does not automatically mean you cannot participate. Since psychological issues / complaints can influence your meditation practice, and vice versa, we like to get in touch with you personally before the start.

Additional comments

Payment *

Payment information must be added here

€  465,00 (double room with bathroom next door)
€  485,00 (double room with private bathroom)
€  560,00 (single occupancy room with bathroom next door)
€  580,00 (single occupancy room with private bathroom)
€  340,00 (room with joint dormitory)

PRIVACY POLICY & GPDR
The registration of your data is subject to data protection. Your data will only be accessible to the Eamba team for organizational purposes, and to the teacher. Your data will not be sold or passed on to third parties. All persons with access to these data commit to keeping them confidential. EAMBA treats your data with care. After the retreat the data needed by the retreat teacher will be deleted. Only your name and email address will be saved to update you on eamba Retreats.
* I have read the Privacy Policy and agree that my data are stored electronically .

GDPR
EAMBA treats your data with care. After the retreat - within the month of January 2023 - the data needed by the retreat teacher will be deleted. Only your name and email address will be saved to update you on eamba Retreats.
* I have read and agree the GDPR. .

* I agree with aforementioned conditions and register for EAMBA retreat 2024 from 02-01-2024 until 07-01-2024.