OPEN AWARENESS MEDITATION RETREAT
Handphone No/home No:
Next of kin to be contacted in case of emergency:
Meditation experience: Yes / No
History of mental abnormality
Other physical health problems: Yes / No
If yes, please state nature of problem
I hereby declare that the above information is true and I am willing to abide by the meditation instructors' advice. Otherwise, I will leave by my own accord. I also understand that the organizers and the meditation instructors shall not be held responsible for any physical or mental injury incurred during or after attending this retreat.
Send me a copy of my responses.
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