Recordings for self retreat
Intake Form
Have you done one or more retreats with Jaya in person?
Yes
No
If yes -- about how many days of retreat with Jaya in all?
7 days or fewer
7 to 30 days
30-60 days
60 or more days
Jaya would love to know what you remember most from your in-person retreat with her (please share a word, a line or as much as you feel).
How did you hear about this set of recordings for self retreat?
Newsletter
Facebook
Email
Word of mouth
Other
Where do you intend to do the retreat? (home/away)
Please describe where.
How many days of self-retreat do you intend to give yourself?
How many hours of retreat a day do you intend to give yourself?
Full days of silence
Half days of silence
A few hours a day
I just want to use the recordings to support my regular practice
Other
If other -- please specify
Why do you want to do this retreat?
How do you think this will enrich your life and practice?
--- Next section is optional ---
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date Picker Icon
Preferred gender pronoun
Female
Male
Other
E-mail
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