2018 Run Mindful Waitlist Step 1 of 2 50% Which retreat wait-list(s) which you like to be on? (check all that apply)* Boulder, CO: June 7-10, 2018 Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*CompanyWebsite Gender*FemaleMaleBirth Date* AgeEmergency Contact Name*Emergency Contact Phone* What type of running do you generally practice? (check all that apply)* road trail sea level / low elevation moderate altitude (2-6,000 ft) high altitude (6,000 ft+) flat rolling/moderate ascents & descents steep ascents & descents What distance of running/hiking do you enjoy? (check all that apply)* 5K / 10K 13.1M 26.2M / 50K 50M+ What is your running/hiking pace?*HikeRun - SlowRun - MidpackRun - FastWhat experience do you have with mindfulness or meditation?*Do you have any Special Dietary Needs? Please indicate if it a preference, intolerance, medical condition or severe allergy.*Sign me up for the Adventure Mindful newsletter.yesnoWould you be interested in sharing a room if we have other roommate requests?*yesnoCan we share your e-mail address with others seeking a roommate?yesnoWe have swag provided by our sponsors and will have to provide sizes on short notice. Please provide us the following sizes in the event we need this information:Shirt Size*Women SmallWomen MediumWomen LargeWomen X-LargeMen SmallMen MediumMen LargeMen X-LargeShoe Size*Cancellation Policy* I have read and agree to the Cancellation Policy. Liability Waiver* I have read and agree to the Liability Waiver. Questions? Email runmindfulretreats@gmail.com or call 920.740.5231.
