2019 Venerable Gavesi 10-Day Vipassana Retreat Registration
April 23 - May 3, 2019 (Check in: April 22, afternoon)
American Bodhi Center
29123 Mellman Rd, Hempstead, TX 77445

Contacts:
Lee Wen: 832-874-1935 or leewen_teh(at)yahoo.com
Jade: 713-456-9741 or yoke_long(at)yahoo.com

Participants must attend the full 10 day retreat. If you are not able to attend the retreat after registration, please notify us as soon as possible so that other standby applicants can attend.

Participants are to observe noble silence, are not permitted to leave the center, make phone calls, or use electronic communication. Please follow the daily schedule.

Accommodation and meals are provided at no cost. Donations are welcome.

Email address *
Personal information
Name *
First (given) name
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*
Last (family) name
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Gender *
Birth date *
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Address *
Street
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City
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State
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Zip
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Phone number *
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Emergency contact *
Name
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*
Phone number
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Dietary restrictions (meals will be vegetarian)
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Have you ever attended any retreat at American Bodhi Center? *
If yes, specify date of last retreat
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Have you ever attended any retreat elsewhere? *
If yes, specify date, location, and length of last retreat
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Location
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Number of days
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Consent and release
I CERTIFY AND ACKNOWLEDGE THAT I have had the opportunity to fully read the American Bodhi Center Retreat Rules. I HEREBY AGREE TO abide by the said rules. As a participant of American Bodhi Center’s Retreat (hereinafter as “Retreat”), I AM FULLY AWARE OF its cost, risks, obligations, procedures, benefits and consequences. *
Required
I UNDERSTAND THAT it is my sole responsibility to inform the staff and/or agents of the Retreat of any medical condition(s) that may affect me while attending the retreat. It is my responsibility to ensure that I have enough of any medication I may be taking for the duration of my stay. I accept full responsibility for my mental and physical wellbeing while attending the Retreat. I AUTHORIZE the staff and/or agents of the Retreat to provide to, obtain, designate, or authorize any reasonable and necessary medical treatment and/or emergency care for me, in the event of my illness, injury or incapacity. I AGREE TO release and forever discharge, indemnify and hold harmless the American Bodhi Center, and/or agents from any claim by myself or my family members arising out of the said illness, injury or incapacity. I UNDERSTAND THAT I will be responsible for any and all charges or fees for the medical treatment, provided either at the American Bodhi Center or at any other medical facilities, deemed reasonable and necessary by the staff and/or agents of the Retreat. *
Required
My medical insurance company is *
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and my policy number is *
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BY PLACING MY SIGNATURE BELOW, I HEREBY IRREVOCABLY COVENANT, PROMISE AND AGREE TO release and forever discharge, indemnify and hold harmless the American Bodhi Center, any affiliated entities, and all of its officers, members, employees, agents, volunteers, and/or servants form and against any and all losses, claims, expensed, suits, costs, demands, damages or liabilities, joint or several, of whatever kind or nature, arising out of or in connection with my attendance and participation in the Retreat. *
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