2024/25 法山护法苑报活动名表格  Dhammagiri-NDR's Activities Application Form

  • 永觉长老指导 Led by Ajahn Cagino
  • 华语讲解  Conducted in Mandarin 
  • 新加坡护法苑  & 法山基金会联合 Co-Organiser by Nibbana Dhamma Rakkha (NDR Singapore) & Dhammagiri Foundation 

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11-17/01/2025 
阿姜查纪念日之行 
AJAHN CHAH’S COMMEMORATION TOUR 
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[地点 DEST.] 泰国乌汶府 Ubon Ratchathani, Thailand

[团费 FEE] SGD400 / RM 1,400 

[详情 Detail ] https//tinyurl.com/DG-AjahnChah-2025

[截止 Closing]:  30.11.2024

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 *
姓名Name ( 同护照 As Per Passport) *
英Eng
别名 Alias  *
另一个名字 An alternate name
护照号码 Passport No. *
请确定您的护照持有六个月的有效期。
Please ensure your passport has at least 6 months' validity on the day you plan to leave Singapore.
 性别 Gender *
出生日期 Date of Birth   *
MM
/
DD
/
YYYY
联络号码 Contact No *
电邮 Email *
 国籍 Nationality *
Required
宗教 Religion *
语言 Language (听 Listening) *
Required
禅修经验 Meditation experience
如有，请注明导师/方法/年数  如: 永觉长老/四念处/2012
If yes, please give details of Teacher/Method/Year. Example : Ajahn Cagino/Satipatthana/2012
曾参与法山-护法苑的活动 Participants Dhammagiri-NDR's Event before *
Required
您是否患有以下病症 Are you suffering from *
Required
现在或过去,有沒有被诊断精神(心理)方面的问题呢？
Do you have, or have you ever had diagnosed with any mental health problems?  
 *
 如有,请说明  If yes, please give details:
紧急联络 Emergency Contact *
姓名Name, 关系 Relationship, 联络号码 Contact No. (e.g:  Tan Kok Ming, Husband, 65-123456)
您是否愿意成为此活动的义工 ? Are you willing to be a volunteer for the trip ?
如是请注明您的专长或是您希望协助的范围.  
If so, please indicate your expertise or the scope in which you wish to assist.
此行与自己/家人/朋友/团体同行 Participant with oneself/family/friends/society.
 *
请注明同行伙伴以方便住宿和交通安排. 
Please indicate accompanying companions for accommodation and transportation arrangements.
如何获悉此活动 How to learn about this event *
Required
备注Remarks
声明Declaration *
i) 本人谨此声明以上所填资料均属真实。
ii) 本人在活动期间将遵从导师或领队的指示，并遵守寺院/团队的所有规则，若有违反将自行离开或主办单位有权取消本人的参与资格。
iii) 本人也明了主办团体将不负责任何本人在活动期间所发生的一切身心健康状况。

i) I solemnly affirm that all the information provided above is true and accurate. 
ii) I hereby commit to comply with the instructions of Ajahn or the team leader, as well as the rules set forth by the monastery or organizers. Failure to do so will result in my voluntary departure. 
iii) I acknowledge that the organizers will not be held liable for any mental or physical injuries that may occur during the activity.
Required
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