Application form: Nirodha's retreat 23.-28.1.2016

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Please fill in all fields in English.

Write "no" if you don't have any comments. You can use the "TAB" key to move to the next field.

All personal information submitted in this form is strictly confidential and will be available only to the teacher and some of the organizers on a need to know basis. All related material will be destroyed after the retreat.

First name *

Family name *

Birth year *

Gender *

Male

Female

Other

Required

When did you pay the reservation fee 30 euros on Nirodha's account? *

Date

Email *

Please double check that your email address is correct!

Street address *

City *

Country (if not Finland)

Please note that because of limited resources, we are not able to help with visa applications in any way.

Phone *

Do you speak Finnish? *

Yes

Not that much, but I understand spoken Finnish

Not that much, but I understand written Finnish

Not at all

Required

Where did you first hear about this retreat? *

Please check all fields that apply. Your answer is important because it helps us to develop our advertising in the future.

Nirodha's mailing list.

Nirodha’s web page.

Nirodha’s Facebook page/event or Facebook feed.

Facebook ad.

Google search.

Web discussion forum.

Ad on a physical bulletin board.

Heard from a friend.

Announcement at a Nirodha event.

Other:

Required

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