This application is for those interested in going on retreat at the CCR Sita Tara Villa in Tuscany, Italy.

General Information
Name*
First Last
Email*
Phone Number with Area Code:
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender*
Date of Birth*

(Day, Month and Year)
Occupation/Profession
The total cost of the each room (excluding food & travel) is $400 per month. There will be a one time cleaning fee of 50 Euros. Will you be able to do this?*
- Yes
- No
Do you plan to continue in long-term retreat?*
- Yes
- No
If you want to stay for shorter retreat, a minimum of four weeks is suggested. We are also accepting applications for retreats of three months, six months, one year or more. How long do you plan to stay in retreat? And when do you anticipate being ready to start your retreat (Month and Year)?*
Did you apply for a previous retreat lead by Alan Wallace?*
- Yes
- No
After a preliminary selection process, individuals may be asked to participate in an interview with a clinical psychologist before final selection is made. Are you willing to participate in this interview?*
- Yes
- No

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General Information

Meditation Experience