Family Retreat 2017 Family Retreat 2017 Schedule Name Annual Family Retreat December 2017 Registration To register yourself and your family for the Annual Family Retreat, December 2017, please fill out the form below. You must provide information for the fields marked with an asterisk (*). First name * Last name * Email Address * Phone * Gender * Female Male Age Group * Child Teenager Adult Senior Street Address Address Line 2 Country * USA (United States of America) Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo, Republic of the Congo, Democratic Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda St. Kitts and Nevis St. Lucia St. Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates UK (United Kingdom) Uruguay Uzbekistan Vanuatu Vatican City (Holy See) Venezuela Vietnam Yemen Zambia Zimbabwe City * State Like to be a volunteer? Yes No Total Attendee(s) 1 2 3 4 5 6 6 and more Arrival Date * Arrival Time Departure Date * Departure Time Need Accommodation at Yugalkunj? * Yes No Special Requests (if any) WAIVER Please carefully read the waiver terms before submitting the registration form. By submitting the registration form you agree to these terms and conditions. Liability Waiver: I agree to hold harmless and indemnify Radha Madhav Society, its directors, volunteers and the owners of the camp property from any claims, damages, losses and/or expenses arising from negligent, willful or intentional acts of the attendees and to assume all liability for any personal injury, bodily injury, illness or property damage that occurs as a result of participation in the retreat activities. Furthermore, the attendees agree to obey all rules and policies mandated by Radha Madhav Society.