Application Form - How To Die A Good Death Workshop with Ayasma Aggacitta at UBV from Sat, 13 Jul 2019 to Sun, 14 Jul 2019
BANDAR UTAMA BUDDHIST SOCIETY
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
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In case of emergency, the next of kin to contact:
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Purpose of joining this workshop *
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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 your retreat? *
If yes, please give details.
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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 submitting 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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