Registration form "10 day residential program"

Full Name *

Pronouns

Birthdate *

Nationality *

Whats app *

Email Address *

Emergency contact *Please provide the contact details of a person to call in case of emergency, including their name, WhatsApp number, and their relationship to you.

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *MontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserrat

We’d love to learn a bit about you and your story. *0 / 300

Why would you like to join this program? *0 / 300

At Paleohori, living and practicing conditions include limited electricity, outdoor showers, shared accommodation in tents, encountering bugs and animals, etc. Are you comfortable with these conditions? *YesNoOther

Other

Every participant is invited to take responsibility for their presence in the space by contributing to its daily care. This involves small, collective, and individual efforts to keep the shared space clean, well-maintained, and tidy. These are simple daily rituals rather than labor-intensive tasks and are expected from everyone staying in the space, as it will be our ‘home’ for a while. Are you comfortable with dedicating some hour daily to help with this? *YesNoOther

Other

Do you have any health issues or medical conditions we should be aware of, or are you taking any prescribed medications? *

If you have any allergies, intolerances, or other crucial dietary information we need to know about, please note it here so that we can take it into account. *

How did you hear about this program? This helps us improve our communication channels. *A person who has been there told meI have been there beforeInstagramFacebookGroups in FacebookWhats appΝέαGoogleWebsited listing dance eventsOther

Other

Select payment range *"Supporting" €821 – €1140"Regular" €820"Supported" €819 – €675Our sliding-scale pricing is based on trust and solidarity. Please choose the range that best reflects your current financial capacity. A €350 deposit is required in all cases to secure your spot. After your place is confirmed, we will email you to outline your remaining balance. The remaining balance must be paid no later than one month before the start of your selected program.

Selected payment amount (€) *Specify the total amount in euros you wish to contribute for the program, within the selected range. This is not the amount required to secure your spot at this stage.

Terms & Conditions *

Yes, I agree with the terms and conditions.

Consent *

I hereby declare responsibly that all the above answers provided by me are true and accurate. 

Credit / Debit Card *

Secure your spot

If you have any problems completing the payment, you can reach out via our email: paleohoriartspace@gmail.com