SMC Retreat Registration Form
03-Days Retreat in Singapore 19th April (Friday) 2019 – 21st April (Sunday) 2019
Registration Contact Info
e-mail: smc.retreat@gmail.com

For Retreat related please contact:
Hnin Hlaing Oo: 9230 6766
Swe Lin Mu: 9383 7084

For Meals & other donations please contact:
Nyein Htay San: 9825 0131
Ei Ei Kyaw: 9760 9125


Form for Donations : http://goo.gl/forms/O6YnjG66vC

facebook:
https://www.facebook.com/smc.meditation

Yogi Information
Name: *
Your answer
Passport No/NRIC/FIN: *
Your answer
Profession: *
e.g. Accountant, Doctor, Nurse, Teacher,...,etc
Your answer
Gender *
e.g. Male/Female
Age: *
e.g. 33
Your answer
e-mail: *
e.g. yogis@gmail.com (communication mails will be sent to this address)
Your answer
Please indicate your preferred Language *
Nationality: *
S’porean / Myanmar
Contact No.: *
Mobile/Fixed Phone: 90070079 (only 8 digits)
Your answer
Address: *
e.g. 700 Jurong West Ave 5, #07-007
Your answer
Singapore Postal Code: *
Please Key in the number only e.g. 580700
Your answer
Retreat Related
Please bring your valid Singapore ICA document & a photocopy if you are staying over night. *
e.g NRIC/EP/SP/
In addition to above, please bring below 3 items if you are staying over night. *
1. Mattress Cover 2. Pillow Cover 3. Paper or cloth Bags (No Plastic Bags) to reduce noise or sound
Use of Mobile Phone is not allowed during the Retreat. [Full-Time & Part-Time Yogis must surrender their mobile phones to SMC. Day Yogis must set their phones to silent (without viberate)] *
Phones will be returned with IC etc photo copy on the last day!
As this is a short retreat session Smoking & Chewing Beetle leaves are not allowed as it will effect Yogis concentration! *
Please indicate that if you are on vegetarian only diet. *
Please indicate if you are interested to receive updates related to future retreats or religious events. *
Please indicate each & every day in below dates.
For overnight must practise minimum 2 Days & 2 Nights
Day0 (Thursday) 18/04/2019
Day1 (Friday) 19/04/2019 *
Day2 (Saturday) 20/04/2019 *
Day3 (Sunday) 21/04/2019 *
Meditation Experience Related
Please indicate your meditation related experience: *
Type of meditation method
Medical Condition
Please proceed to Next Session, if No special medical conditions!
Please indicate if you are in any long term medication or medical conditions
Can Skip If no condition
Mental Condition
Please proceed to Next Session, if No issues
Any history of physical or mental health issues? *
Last Date of Treatment if Any:
MM
/
DD
/
YYYY
Emergency Contact Info
Contact Person: kay khaing *
Jason Lim
Your answer
Relationship: *
Spouse/Relative/Friend/Others
Contact No. *
Mobile/Fixed Phone: 90070079
Your answer
Declaration
I declare that the information given in this application form is true and correct. I understand that the Centre reserves the right to reject my application and / or ask me to leave should the information, in whole or in part, proved to be materially untrue and incorrect. Furthermore, I shall not hold the Centre responsible and/or liable for any mishap, unforeseen incidents, physical or mental illness that may occur before, during and/or after the intensive retreat. I undertake to abide strictly by the rules of the Centre, to learn and practise sincerely and conscientiously and to follow closely the advice and instructions of the teacher. I will not hold the Centre liable and/or responsible for any items lost at the retreat premises. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service