12/22-29 2018 彌陀佛七 Amitabha Retreat Application
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Name 英文： *
中文姓名：
Address 地址： *
Home Phone Number 家聯絡電話 *
Cell Phone Number  手機 *
Age 年齡： *
Highest Education 學歷： *
Gender 性別： *
Required
Occupation 職業： *
我能參加？全程或隨喜幾天 *
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。
能否於12月22日3:30pm之前，到達山上，參加灑淨、儀軌講解？ *
I will need transportation from Cold Spring Station to Chuang Yen Monastery. 我需要12月22日下午Cold Spring火車站到莊嚴寺的交通接送 *
Please take 12/22 12:45pm train from Grand Central Station. We will only provide transportation at the Cold Spring train station 2:07pm. The pick up van will leave on time.
語言 Language *
Required
Religion 宗教信仰 *
Refuge Master 皈依法師 *
Refuge Date 皈依日期 *
戒別 Precept Designation
曾參加過本寺的佛七嗎?   Have you attended this retreat before?   *
Required
您是否有身心健康上的問題? Do you currently have any physical or mental health problem? *
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? *
緊急連絡人姓名 Emergency Contact Person： *
緊急連絡人關係 Emergency Contact Relationship： *
緊急連絡人電話 Emergency Contact Telephone *
(Please include all Day, Night & Cell Phone Number)
*
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。
Required
參加者簽名 Signature： *
日 期 Date： *
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