APPLICATION FOR PERSONAL RETREAT AT HOKOJI

Please complete a separate form for each person requesting retreat.

Name

First Name

Last Name

Email

Inspiration for visiting

It's helpful to let us know a little about your plans at Hokoji so we can help you find what you are seeking

Arrival Date

MM

DD

YYYY

Departure Date

MM

DD

YYYY

Number of Guests

Please let us know the number of people in your group, including yourself.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Who should we call in case of emergency.

First Name

Last Name

Emergency Contact #

Please let us know your emergency contact's phone number

(###)

###

####

Text

Hokoji subsists on donations. A $65 per day donation is expecteD. YOUR APPLICATION WILL BE REVIEWED PRIOR TO YOUR REQUESTED DATE. IF YOUR APPLICATION IS ACCEPTED SOMEONE WILL MEET YOU FOR CHECK-IN AND DEPARTURE.