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Test Registration Form

THIS FORM IS FOR TESTING PURPOSES

Registration for “Resting in Ordinary Mind: Mahamudra Recognition & Spontaneous Liberation, May 1-3, 2026, In Person and Online“

Name

This field is for validation purposes and should be left unchanged.

RETREAT PRICE: $195 in person and $125 by zoom

How will you attend, In Person or By Zoom?(Required)

In-Person ($195 per person)

By Zoom ($125 per person)

Number Attending(Required)

Scholarships

I/we have a need for a scholarship

REQUIRED: Please tell us about your particular situation and why you are applying for a scholarship.(Required)

Please select a scholarship amount based on your need.(Required)

30 percent discount

60 percent discount

If the scholarship discount does not meet your needs, please contact us at [email protected].

Attendee 1

Attendee 1 Name(Required)

First Last

Attendee 1 Email(Required)

Attendee 1 Phone(Required)

Attendee 1 Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attendee 1 Seating Needs(Required)

Floor cushion

Chair

Attendee 2

Attendee 2 Name(Required)

First Last

Attendee 2 Email(Required)

Attendee 2 Phone(Required)

Attendee 2 Address(Required)

Same as Attendee 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attendee 2 Seating Needs(Required)

Floor cushion

Chair

Attendee 3

Attendee 3 Name(Required)

First Last

Attendee 3 Email(Required)

Attendee 3 Phone(Required)

Attendee 3 Address(Required)

Same as Attendee 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attendee 3 Seating Needs(Required)

Floor cushion

Chair

Program Cost

Program Fee

Price: $0.00

Scholarship Discount

Price: $0.00

Optional Donation to Tana Yelpa Foundation

Processing Fee Contribution

I would like to cover the processing fee of 3%

Processing Fee

Price: $0.00

Payment Summary

Coupon Code

I have a coupon code

Coupon Code

Total Cost

Payment Details

Payment Method(Required)

Paypal

Credit Card

Payor Name(Required)

First Last

Payor Email(Required)

Add any Additional Comments (Optional)

Payment Method(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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