AJAHN MARTIN MEDITATION RETREAT 2018
Date: 1ST - 6TH MAY 2018
Venue: Bodhi Park ,Shah Alam
1A, Persiaran Serai Wangi, Seksyen U12, 40170 Shah Alam ,Selangor , Malaysia
* Required
PERSONAL PARTICULAR
Name:
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Your answer
NRIC Number:
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Please do not include the hyphen sign (-)
Your answer
Birthday
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MM
/
DD
/
YYYY
Gender:
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Female
Male
Address:
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Your answer
Mobile Number:
*
Your answer
Email:
*
Your answer
NEXT OF KIN TO BE CONTACTED IN CASE OF EMERGENCY
Name:
*
Your answer
Relationship:
*
Your answer
Mobile Number:
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Your answer
MEDICAL HISTORY
Do you have any health, physical or emotional problems?
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No
Yes
Are you currently taking/on any form of medication (prescribed or otherwise)?
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No
Yes
If your answer is yes for the above, please specify
Your answer
During the retreat, I would like to observe
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5 Precepts
8 Precepts
Meditation Background
State on if you attended any Meditation classes or Meditation Retreat?
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Yes
No
Duration of Retreat Attended
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Your answer
Method of Meditation and Meditation Teachers Name
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(e.g. Method - Teachers Name) * Note: Press enter for next line
Your answer
ACKNOWLEDGEMENT
I hereby declare that all the above information provided is correct. I agree to abide by the instructions of our teacher Ajahn Martin and the rules & regulations set by the organising committee, otherwise I will be asked to leave. I understand that the organizer will not be responsible for any physical injuries sustained during the retreat. I also understand that the organizers reserve the right to amend any rules and regulations which they deem fit and necessary for the smooth running of the retreat.
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I acknowledged the above
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CLOSING DATE : 15TH APRIL 2018
REMARKS:
The retreat is free of charged and will be supported by sponsors and donations. You are encouraged to make donations to support the cost of the retreat. Donations of any amount is welcomed.
All sponsors or donations shall be payable to :
Ti-Ratana Community Center Penchala
CIMB Bank – 8001450727
Bank in slip can be send though channel below:
1.) E-mail to
tiratanapenchala@gmail.com
2.) Text or whatsapp the picture of the transfer slip to Sis Yuh Ming (+60122313341) or Sis ST (+60123313171)
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