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12/22-29 2017 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 _______
請寫清楚參加日期,並預估抵達時間,請儘量準時到達,以便我們準備諸多事項。
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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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Applicant for this retreat hereby agrees not to hold BAUS (The Buddhist Association of the United States) and Chuang Yen Monastery liable for any personal illness and/or injury is suffered during the retreat or if any property is damaged, lost, or stolen while a participant is at the retreat. 我對以上表格回答屬實,且於活動期間,如有病痛、金錢、物質之損失、任何意外事件而受到傷害, 概由參加者自行負責,美國佛教會及莊嚴寺不負任何法律責任、賠償責任。
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參加者簽名 Signature: *
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日 期 Date: *
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