Simhamukha The Lion Headed Dakini

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1 Welcome

2 Price

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$695.00 – Sustaining Level

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$895.00 – Benefactor Level

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$495.00 – Supported Level

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3 People in your group

Guest 1		First Name* Last Name* Gender Email*
Guest 1		First Name* Last Name* Gender Email*

4 Participant Info

Preferred Name	Please note our system will automatically use your legal first name in communications, but we will make every effort to address you by your preferred name during a retreat
Gender
Occupation
Date of birth *
Primary Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Do you meet the prerequisites? *	Yes No
Name of Emergency Contact *
Relationship to emergency contact
Emergency Contact Phone Number *
Is this your first Tara Mandala program? *
How did you hear about this program?
More detail on how you heard about this retreat/event	If you'd like, please share more details about how you first learned about this program, such as the name of the publication or person you were referred by.

5 Review Waivers and Policies

6 Donate

7 Payment