2018精進太極禪七 Tai Qi 7-day Intensive Retreat◆Application Form
Welcome to the Intensive -day Retreat at Chan Grove! Please fill in the registration form below and email to inquiry.ccc@gmail.com. We will reply within 10 working days about our admission decision. Please fill in the form completely. Thank you.
Venue:198, Fuxing 3rd Road, Beitou District, Taipei City, Taiwan
Nov 24 (Sat.) 18:00-18:30 Register,
Nov 30 (Fri.) 12:00 Retreat concluded
* item must be filled in
歡迎您報名參加2018.11.24~11.30的中英精進太極禪七活動!請您完整詳實填寫報名資料。我們將在收到您的報名表後10個工作天內,寄發錄取通知。
為提高報名流程的作業效率,資料不齊全者恕不受理。請您珍惜報名和錄取的機會。任何疑問請電洽 (02) 2891- 5205 (※活動地點:台灣台北市北投區復興三路198號/祖師禪林 )
Personal information/個人資料名
Name/姓名 *
Your answer
Date of Birth/生日 *
EX: 1972.03.21
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Gender/性別 *
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E-mail Address/電子信箱 *
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Nationality/國籍 *
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Marital Status/婚姻狀態 *
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Correspondence Address/通訊地址 *
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Contact Number(Day) /連絡電話(日) *
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Mobile/行動電話 *
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Shuttle Bus/接駁車 *
Required
Emergency Contact/緊急聯絡人 *
Name/Relationship/Contect Number (姓名/關係/連絡電話或行動電話)
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Highest Education(學歷)
School/Department /Degree(學校/科系/學位)
Your answer
Company(服務單位)
Position(職位)
Your answer
Religion(宗教信仰) *
If you are a Buddhist, who is your Master?(皈依師)
Your answer
Meditation books and authors you read(主要閱讀的禪修著作及作者)
Your answer
What do you wish to get out of this retreat?(參加動機,因緣及目的?希望得到甚麼樣的協助及指導?) *
Your answer
Remarks (Special medical attentions or other matters...)備註(特殊體質或其他事項)
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Previous Chán Retreat Experience/禪修經歷
Do you have any Chan Retreat Experience?/是否曾有禪修經驗? *
Shortly Describe Your Chan Retreat Experience/請簡述您的禪修經歷
Your answer
Recent Chan Retreat Experience(Make one example)/最近曾參加的禪修活動(請舉1例)
Name of the Retreat/ Organizers /Date(禪修活動名稱/主辦單位/時間)
Your answer
Have you ever participated in any activities organized by Chan Grove?/是否曾參加祖師禪林或玉佛寺的禪修活動? *
Meditation Experience in the past six months/最近半年禪坐情形? *
Regular Home Meditation or Regular Group Meditation, _____times per week, _____mins each time/固定在家打坐或參加禪坐共修,每周_____次,每次________分鐘
Your answer
Meditation Methods/禪修方法
Health Condition/健康情形
Do you have any of the problems listed below?/是否有右列各項疾病或健康問題? *
Required
Serious emotional or psychological disorders?/嚴重的情緒障礙或心理不適應症? *
If "Yes", Please describe it/如填"是",請略述情況
Your answer
Have you had major surgery?/您是否曾動過重大手術? *
If "Yes", Please describe it/如填"是",請略述情況
Your answer
Other health problems?/其它須特別遵守醫囑的健康問題?
If "Yes", Please describe it/如填"是",請略述情況
Your answer
Do you agree and are willing to abide in the following: (please check/請打勾表示您同意或願意遵守該則注意事項 Throughout the whole Chán Retreat, I agree *
Required
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