ROA 2024 REGISTRATION
DATE: FRIDAY AUGUST 30th to MONDAY SEPTEMBER 2nd
PLACE: YMCA Camp Cullen -- Trinity, TX

SPECIAL RATE IF REGISTERED BY JULY 15: $190 per person.  

REGULAR CAMP FEE: $220 per person.  
Camp fee covers food service, lodging, and all activities. 
Camp staff, wellness professionals, and Dharma teachers are all volunteers. We greatly appreciate any additional donation to help cover ROA signature T-shirts and administrative costs.


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CONTACT INFORMATION
Thông Tin Liên Lạc
Title *
Last Name *
Họ (xin quý Thầy Cô ghi "Thích / Thích Nữ")
Middle Name
First Name *
Tên / Pháp Hiệu
Mailing Address *
Địa chỉ
City *
Thành Phố
State *
Tiểu Bang
Zip Code *
Telephone *
Điện Thoại (xxx-xxx-xxxx)
PERSONAL INFORMATION to help us best accommodate your needs
Thông tin cá nhân để giúp Ban Tổ Chức đạt nhu cầu của bạn
Did you attend any past Retreat of Awakening? *
Gender *
For lodging purpose. 
Age *
Age by August 2024
Marital Status
Tình trạng hôn nhân
T-Shirt Size *
Free camp t-shirt, while supplies last (Được áo thun trại miễn phí nếu ghi danh sớm)
Please specify any medical conditions or special requirements that you may have
Xin nêu rõ nếu có tình trạng sức khỏe cần đặc biệt chú tâm
Please specify any dietary restriction or food allergies?
Emergency Contact *
Emergency Contact Name  -  Relationship  -  Telephone number     XXX-XXX-XXXX  (Tên người có thể liên lạc trong trường hợp khẩn cấp - Quan hệ - Số Điện thoại)        
Language of preference if divided into Discussion Groups? *
Bạn thích dự các giờ Pháp Đàm theo ngôn ngữ nào?
Rate your Buddhist practice *
Trình độ hiểu biết về Phật học của bạn
How did you hear about us (Bằng cách nào bạn biết về Trại Tỉnh Thức)? *
Optional:  Please share the name of other non-profit or community organization/activities that you are involved in
Xin chia xẻ nếu bạn đang sinh hoạt trong nhóm thiện nguyện nào khác
PAYMENT
To avoid the 3.5% fee for payment gateway services, please use one of the following methods to send your payment: (1) Zelle, (2) Venmo, or (3) PayPal to "Friends or Family". It would be greatly appreciated if you could use one of these payment methods to help us save on costs. Thank you so much for your understanding and continued support!
I would like to make an additional donation to the ROA 2024.
All donations are tax deductible in accordance with IRS rules.
I will pay my Registration Fee with: *
Please read the ROA WAIVER. *
Required
Signature of Confirmation of Acknowledgement *
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