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ONLINE REGISTRATION
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Items marked with a * are required and must be completed

Contact Information

First Name *

Surname *

Date of Birth *

E-Mail *

Postal Address *
(inc postcode)

Phone Numbers:

Landline
Mobile
Retreat Information

Previous Retreats Attended *

Current Employment Status *

Room Type Preference *
(Beds will be allocated upon payment of the registration fee)

All single & twin rooms at this years retreat have now been allocated. If you would like to go on the waiting list for a single or twin room, please state this in the extra information section at the bottom of the form.
(people will be added to the waiting list upon receipt of payment, and cleared from the waiting list if there is a cancellation in the same order)
Registration Fees for 2012 are as follows:
  • $80 for a waged/employed person
  • $40 for an unwaged person with Community Services card and/or on a WINZ benefit
  • $30 for Marae style sleeping
This fee covers all accommodation, meals, the retreat programme, and assists with transport to the event if required.
Beds will be allocated upon receipt of payment, on a first come first served basis (please note that the Wellness Fund will not be covering any Registration Fees this year)

Would you like to make an optional extra donation to the above fee to assist with overall cost of the retreat?

If you require a twin room, is there someone you would prefer to share with?

Transport Information

If coming from outside of Auckland, do you require assistance with TRANSPORT to get to the Retreat?

  1. No
  2. Yes
If yes, please give details of the assistance you will require below:

Do you have a current Community Services Card?

  1. No
  2. Yes
If yes, please enter the details below:

Will you be using the FREE BUS provided from Body Positive House to get to the Retreat and back?

  1. No
  2. Yes
Other Information

Do you have any HEALTH ISSUES we need to be aware of?

  1. No
  2. Yes
If yes, please give details below:

Do you have any special DIETARY NEEDS we need to be aware of?

  1. No
  2. Yes
If yes, please give details below:

EXTRA INFORMATION: (Use this space to let us know of anything else you require to ensure you have an enjoyable Retreat)

If you are unable to complete the Registration Form Online for any reason you can also download a printable version here, or alternatively contact us to express your interest in attending and we will post you a booking form to complete.