Online Application

Please fill out the form below if you are interested in attending the first annual Retreat with Swami Bhoomananda Tirtha, May 28 to May 31, 2010, in Warrenton, VA. A CIRD representative will contact you with details and next steps.

First Name:
Last Name:
Street Address:
City:
State:
Zip:
Phone:
Email Address:
Birth Date:
What is your objective in attending this retreat?
What is your current spiritual approach or practice?
Is there anything else you would like us to know concerning your interest in this retreat?
Please let us know how you learned about the retreat.