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12/23-30 2016 彌陀佛七 Amitabha Retreat Application
Name 英文:
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中文姓名:
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Address 地址:
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Home Phone Number 家聯絡電話
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Cell Phone Number 手機
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Email address 電子信箱地址:
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Age 年齡:
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Highest Education 學歷:
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Gender 性別:
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Occupation 職業:
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我能參加 I can attend:______ 天 Days 從 From December _______ to December _______
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語言 Language
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Religion 宗教信仰
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Refuge Master 皈依法師
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Refuge Date 皈依日期
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戒別 Precept Designation
曾參加過本寺的佛七嗎? Have you attended this retreat before?
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您是否有身心健康上的問題? Do you currently have any physical or mental health problem?
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簡述參加動機及期許 State briefly why you have decided to join us this time and what do you intend achieve?
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交 通 Transportation
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緊急連絡人姓名 Emergency Contact Person:
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緊急連絡人關係 Emergency Contact Relationship:
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緊急連絡人電話 Emergency Contact Telephone
(Please include all Day, Night & Cell Phone Number)
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參加者聲明:如參加法會期間,若有病痛,金錢或物質之損失,及任何意外事件因而受到傷害,概由參加者 自行負責,美國佛教會或莊嚴寺不負法律及賠償責任。 Waiver of Liability: It is fully understood that the BAUS and/or Chuang Yen Monastery cannot be responsible for illness or injury suffered during the retreat. I am fully responsible for the damage or loss of my personal belongings.
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參加者簽名 Signature:
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日 期 Date:
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