Thank you for your enquiry, and intention to attend this year s retreat with Subhana and Carol.

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1 Open Heart, Open Mind Silent Meditation Retreat With Subhana Barzaghi and Carol Perry Kallara, Strathbogie, Victoria Thursday 22 nd Thursday 29 th October 2015 Thank you for your enquiry, and intention to attend this year s retreat with Subhana and Carol. About the retreat The retreat will be based on periods of sitting and walking meditation, usually around 45 minutes each. There will also be two gentle yoga classes, a meditation instruction period, and a dharma talk, each day. There is potential to rest throughout the day and there are regular small group and private interviews with the teachers. The retreat will start with dinner at 6:00pm on 22 nd October, and finish with lunch at 12:00pm on 29 th October. Please note: This Melbourne Insight meditation retreat will offer a family integrated practice and has made available two spaces on this forthcoming retreat for two families. They will participate and sit with the group but have their meals and other family activities separate to minimize any disruption. This option is available only for long-term practitioners and members of the MIM group. If you are interested in this option in the future please contact the organisers. About Kallara Please be aware that Kallara can be very cold in winter, and cold spells can occur during other times of the year, so bring plenty of warm clothing and bedding. There is no mobile phone reception available at Kallara (an emergency phone is available if required). Accommodation Accommodation at Kallara is in simple but comfortable shared and single rooms, with shared bathroom facilities. Bedrooms are unheated you are welcome to bring a small heater for your room (power is available in each room). Mattresses are provided; however you will need to bring all your own bedding, pillows and linen. Food and catering Three nutritious vegetarian meals will be provided each day. If you have specific dietary requirements, please indicate this on your registration form, so that we can organise your requirements with the cook. Retreat costs 7 day retreat $595 MIMG is a not-for-profit organisation, and the retreat costs above cover the basic costs of food, accommodation, and administration costs associated with offering the retreat (i.e. teachers airfares, insurance, MIMG administration). The retreat costs do not cover the teachings, as these are offered freely in accordance with the Buddhist tradition. Students are invited to make a dana (donation/gift)

2 offering to the teachers via the dana box at the retreat, or directly to them via a EFT transfer (details will be given in the confirmation letter). If you are unable to pay the full cost of the retreat due to financial circumstances, please contact the Registrations Manager to discuss a supported place on retreat. Booking for the retreat Retreat costs are below with a minimum non-refundable deposit of $100 required to confirm your booking. If possible, please prepay the full amount. Early registration and full payment is encouraged, as places are limited. If the retreat is fully booked upon registration, you will be notified and your name will be placed on a waiting list. You would then be contacted as soon as a place is available. To secure your place on the retreat, you will need to do ALL THE FOLLOWING 3 STEPS: 1. Make payment: a) EFT (preferred method), to the following account: Bank: Westpac BSB: Acc number: Account name: Melbourne Insight Meditation Group VERY IMPORTANT: As reference to your payment, please specify October retreat and INCLUDE YOUR NAME (so we can confirm your payments) b) Cheque, made payable to Melbourne Insight Meditation Group, and mail to Robyn Gibson, PO Box 965 Castlemaine Victoria Confirm payment: Once your payment is made, please the following to insightretreats[at]hotmail.com: 1. Your full name 2. Date of payment 3. Method payment (EFT or cheque) 4. Amount paid Please note: the balance of your fee is due no later than Friday 2 nd October If your balance is not paid by this date, your place on the retreat may be offered to someone else. 3. Send your Registration Form: Complete your registration form, and either a) scan and to insightretreats[at]hotmail.com (replace [at] or b) post a hard copy to Robyn at PO Box 965 Castlemaine Victoria 3450 When your Registration Form and deposit or full payment has been received, a confirmation letter will be sent to you with practical details about the retreat (directions, what to bring etc.).

3 Cancellation Policy We understand that circumstances change, and that people sometimes need to withdraw from a retreat booking. However, it is also important that people on a waiting list are given a reasonable amount of time to accept a cancellation space. We therefore require that you pay the full amount of the retreat cost by Friday 2 nd October. If your balance is not paid by this date and you have not contacted us, your place on the retreat will be offered to someone else. Cancellation fees apply as follows: a) Cancellation at any stage means loss of deposit ($100) b) There are no refunds or discounts for early departure from the retreat, or late commencement. Please arrange work and personal commitments in order to stay on the retreat grounds for the full duration of the retreat. Thank you. With warm regards, Robyn Gibson Retreat Registrations Manager

4 Registration Open Heart, Open Mind Silent Meditation Retreat Thursday 22 nd Thursday 29 th October 2014 Name: Address: Gender: Age: Phone Work/Home: In case of an emergency during the retreat, who would you like us to contact: Name Relationship Phone contacts Personal Requirements: Catering are you ok with a standard vegetarian menu? YES / NO Do you have any specific dietary requirements (not just preferences)? YES / NO Please indicate: Do you have sleep issues that may disturb others? YES / NO Any other specific needs, please give details. Transport / First Aid: Vehicle reg. number (if parking at Kallara): Can you offer a lift to/from Kallara? One way Return No. of people: From: Would you like a lift One way Return From: to/from Kallara? Are you able to offer first aid assistance if required YES / NO during retreat (i.e. do you have accredited first aid training)?

5 Information for the Teacher Open Heart, Open Mind Silent Meditation Retreat Thursday 22 nd Thursday 29th October 2014 CONFIDENTIAL - (for Teachers and managers only) Name: (please print and underline preferred name) Life Situation/occupation: Age: Male or Female : Current Meditation Practice (if any): Previous courses with Subhana/Carol: Previous Meditation: Retreats or related practices Please state Tradition(s) Teacher(s) Year Length Current Issues that may make meditation difficult for you at this time: Physical: Mental / Emotional: Spiritual: Many meditators are on a healing journey. On meditation retreats individuals may experience strong physical and psychological states. Please answer all the following questions so we can care for you appropriately. Do you have any current or previous (please outline in space provided if yes): Drug (including alcohol) abuse or addiction issues? Yes/No/Past/Current

6 Diagnosis or treatment of a mental illness (psychological or psychiatric)? Yes/No/Past/Current Medical conditions that could require attention during the retreat? Yes/No/Past/Current CONFIDENTIAL INFORMATION FOR TEACHERS / MANAGERS ONLY If you answered Yes to questions above, please give further information of your conditions: Are your symptoms currently well controlled? Do you currently drink alcohol on a regular basis? If so, have you ever had any problems abruptly stopping alcohol usage? Do you currently use recreational drugs (e.g. marijuana, amphetamine, ecstasy)? If so, are you able to abstain from all recreational drugs during your retreat? Have you ever made a serious attempt at taking your life? Do you have a history of emotional instability during intensive meditation retreats? How do you assess your current ability to work with emotional swings? PLEASE ANSWER ALL THE FOLLOWING: Any condition that might interfere with sitting and walking meditation? Any limitations that prevent you from participating in the daily work period? Are you currently taking any prescription medications for physical or psychological conditions? If so, please list each medication and daily dosage, as well as the condition it is being used to treat below: Condition Current Effect on Daily Life Treatment Including medications. Hospital admissions Current Doctors or Therapists Name & address By signing my name below, I confirm that all of the above information is correct to the best of my knowledge. I will inform the teacher/manager of any change in my circumstances. Name (please print): Signature: Date: / / 2015

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