Registration: 2-Day Pureland Retreat with Ven. Ching Chao

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You are registering for the 2-Day Pureland Retreat led by Ven. Ching Chao.
Please filled out the application form correctly.

Date: Saturday, July 4, 10a.m. - July 5 4p.m., 2015 (12 -1:30p.m., lunch break)
Check-in: 9a.m. - 9:45a.m.
Open to all. Donation to help cover the expenses is requested.
Thank you for joining us in growing a peaceful and joyful community.

Lansing Buddhist Association

Name

Gender

Male

Female

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E-mail

Phone Number

Emergency Contact Name and Phone Number

Address

Age

Do you have a medical condition that needs attention?

Yes: Please inform the retreat organizer before the retreat.

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Would you like to be on LBA e-mailing list?

Yes, please put me on the list.

Yes, but I am already on the list.

No, thanks.

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By checking the following box, I agree to relieve Lansing Buddhist Association from all liabilities in the event of any injury or illness incurred while I am on the retreat center property.

Yes

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Note

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