Key information (please read carefully):

• Please note that completing this form does not automatically ensure your retreat booking is confirmed. Retreat places are limited and in high demand, and so are booked on a first-come/first-served basis. Completing this form is an indication of your interest/intention to come to a retreat(s), but your place in the retreat(s) will be individually confirmed by phone or email as soon as possible.

• Please note that indications of interest will only be accepted with payment authorisation by credit card at the time of submitting this form. If you are not yet ready to pay for retreats at this time, please do NOT complete this form. Your credit card will not be debited until your place in the retreat(s) has been confirmed.

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Other information:

• 2012 program: The retreats listed are outlined in the 2012 Program PDF (current as at 9 December 2011). For more information about any of the individual retreats, please click here.

• Membership discount: If you are a current WellSpring member, you can enjoy a 10% discount off the cost of all retreats.

• Becoming a member: If you are not yet a WellSpring member, you may wish to consider joining. Simply click here to join or renew your membership and then return to this page to complete your indication of interest form to enjoy a 10% discount off the cost of all retreats.
  

• Authorising payment: Upon completion of this form, you will be taken to a secure payment page where you can safely enter your credit card details for authorisation. NB: Your credit card will not be automatically debited, but rather your details will be retained for processing at the time your booking is confirmed.

• Deposits: There is provision here to authorise payment for just your initial $50 deposit ($45 for members), or for the whole retreat. To authorise payment for the whole retreat, please tick both the Deposit and the Balance boxes.

• Cancellations: Refer here for the cancellation policy regarding retreats.

• NB: This form is for one retreatant only. If you are hoping to attend with another family member or friend, each person should fill in and submit the form separately.

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Indication of interest/payment authorisation form

Retreat	Date	Tick	Cost	Sub-total
Creative Play Retreat (Peter Bentley)	Friday 27 to Sunday 29 April (Deposit)		$50	$
	Friday 27 to Sunday 29 April (Balance)		$235	$
Mysteries too Marvellous to be Understood (Barbara Rautman and Margaret Donald)	Friday 25 to Sunday 27 May (Deposit)		$50	$
	Friday 25 to Sunday 27 May (Balance)		$235	$
Private Retreat (Mary McCowan)	Friday 1 to Sunday 3 June (Deposit)		$50	$
	Friday 1 to Sunday 3 June (Balance)		$235	$
Weeklong Private Retreat by the Sea (Jill Manton)	Wednesday 22 to Wednesday 29 August This retreat is now full. To be placed on the waiting list, please email retreats@wellspringcentre.org.au. If you have already enrolled and paid a deposit, and now wish to pay the balance of your payment, please contact Monique for more details. NB: For security reasons, please do NOT submit credt card details by email.
The Door of the Heart (Kaye Evans)	Friday 14 to Sunday 16 September (Deposit)		$50	$
	Friday 14 to Sunday 16 September (Balance)		$235	$
The Heart of the Mystics (Margaret Donald)	Friday 19 to Sunday 21 October (Deposit)		$50	$
	Friday 19 to Sunday 21 October (Balance)		$235	$

 

     

 

 

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CHECKOUT

TOTAL (before membership discount):	$
Please indicate if you are a current WellSpring member:	Non-member Member
TOTAL PAYABLE (including 10% membership discount if applicable):	$

 

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PERSONAL DETAILS

Name:
Email:
Phone:
Mobile:
Address:
City/Suburb:
State:	Select a state -------------- ACT New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia
Postcode:
Is this your first silent retreat? (Yes/No)
Special dietary requirements:
Any physical limitation or other needs it would be helpful for the retreat team to be aware of to ensure your comfort while on the retreat:
NB: Please ensure you only press the 'Submit form and authorise credit card payment' button once. Do not press this button unless you are ready to authorise payment with your credit card – indications of interest will only be accepted with credit card authorisation at the time of submitting this form.