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Waiting List Application

We will be in touch within 48 hours of you completing this form to confirm whether a place is available and if not that your name has been added to the Waiting List for this retreat. By completing this form you are indicating that you will be able to take up a place, should one become available. Please email us at ku.oc.esuohaiagnull@ofni or  call us on 01626 333613 as soon as possible if your plans change so that you would no longer be able to take up a place if it is offered.

Name and Contact Details

First Name *
Last Name *
Address *
Town/City *
County / State
Post Code
Country *
Email Address *
Telephone Number *
Additional Telephone Number

Personal Details

Gender *  Female Male
Year of Birth* -e.g. "1954"
Have you attended a retreat at Gaia House in the last 5 years? *  No Yes
You may add any additional information:

Please add me to the Waiting List for the following retreat:

To be added to the Waiting List, Please Select a Retreat from the Drop-Down List ===>

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