Application Form - Dhamma Leadership Camp (with meditation) by Ven. Buddharakkhita at UBV on Sat, 21 Sep - Sun, 22 Sep 2019
BANDAR UTAMA BUDDHIST SOCIETY(Reg No. 364)
A Dhamma inspired community in the heart of Petaling Jaya
3 Jalan BU 3/1 Bandar Utama 47800 Petaling Jaya.
Tel No. : 03-77106010/6013 Fax No. : 03-77106012
Web page: http:// www.bubs.my Email: office@bubs.my
I/C No *
Please put in this format (XXXXXX-XX-XXXX)
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Name *
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Personal Details
Age *
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Gender *
Address *
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Marital Status *
Telephone Number (House) *
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Telephone Number (Office)
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Telephone Number (Mobile) *
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Email *
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Religion
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Member of BUBS *
In case of emergency, the next of kin to contact:
Name *
Your answer
Address *
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Relationship *
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Telephone number (House) *
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Telephone number (Mobile) *
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Religious Organisation (associated with)
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Meditiation Experience *
Type of Meditation *
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Teacher's Name *
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Length of longest retreat
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Duration per practice *
Sitting
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*
Walking
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Purpose of joining this camp *
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A) Any contagious diseases like TB or advanced diabetic that require constant treatment? *
B) Any health complications, restrictions, physical/psychological disorder that may or will affect you during the camp? *
If yes, please give details.
Your answer
I hereby declare that the above information is true I am willing to abide by the workshop instructor’s advice and the Society regulations; otherwise I will leave on my own accord. I also understand that the organisers and the workshop instructor shall not be held responsible for any physical or mental injury incurred during or after attending this workshop. *
** Personal Data Protection Act 2010 By signing this form, you consent to us processing and using your personal data in the manner as permitted by law and as stated in our Privacy Policy. An on-line copy of our latest Privacy Policy is located at https://bubs.my/privacy-policy
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