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Free to Be: July 4th Family Day Pass

* These fields are required

1 Welcome

2 Choose your package

3 People in your group

Guest 1		First name* Last name* Email* Phone (daytime)* I identify my gender as:* Your answer will support gender-based shared room assignment. If you identify as trans, non-binary, neutral, or otherwise genderqueer and are sharing a room, please select a gender that you are most comfortable sharing a room with. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.
Guest 1		First name* Last name* Email* Phone (daytime)* I identify my gender as:* Your answer will support gender-based shared room assignment. If you identify as trans, non-binary, neutral, or otherwise genderqueer and are sharing a room, please select a gender that you are most comfortable sharing a room with. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.

5 Delaware Highlands Conservancy Donation

6 Tell us about yourself

Phone (daytime) *
Address line 1
Address line 2
City or region
State or province
Zip or postal code
County *
Country *
Diet Needs *	Our nutritionally balanced vegetarian meals are freshly prepared by our kitchen staff and served with homemade whole-wheat bread and homemade gluten-free bread. We will work hard to meet your special dietary requests but cannot guarantee to accommodate every individual request. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.
Anything else that you'd like to tell us?	Roommate request? Any severe dietary allergens? Any medical issues? Questions about this program or the registration process? Recommendations for a future program? Comments about how Himalayan Institute programs have impacted your life?
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Age
Arrival Time	Please Enter the time when you expect to arrive at Himalayan Institute

7 Confirm your registration

Wisdom. Service. Community.
952 Bethany Tpke, Honesdale, PA 18431 USA
800 822 4547
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