Event Registration Form

Email*
Legal Name*
First Last
Spiritual Name if initiated (otherwise mark it N/A)*
Age*
Enter the age in numeric format only. ie: 18, 25, 75 etc.
Please enter a number less than or equal to 100.
Your Location City (e.g. Toronto, London, New York, etc.)*
Your Location Country (e.g. Canada, UK, USA, etc.)*
Phone number (with country code)*
Is this your first time attending a MAN-tra retreat?
- Yes
- No
How did you get to know about this year’s MAN-tra retreat?
- Email notification
- Local Temple announcement / Notice board
- Facebook / Social Media
- Word of mouth
Any special requirements? (e.g. Accommodation preference, Dietary, etc.)

Product Name*
- Option 1: Shared room package (shared accommodation and prasadam included) USD 249
- Option 2: Single occupancy room package (single occupancy accommodation and prasadam included) USD 344
- Option 3: Without accommodation package (prasadam included) USD 144
- Option 4: New Vrindaban local resident package (without accommodation and prasadam) USD 39
Total
$0.00
Credit Card*
Card Details
Cardholder Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
This field is for validation purposes and should be left unchanged.

MAN-Tra Retreat 2024