DZG Zazenkai 19th April
Friday 19th April Buddhist Temple Leanyer, 6:00am- 3:00pm.

You are invited to register for a Day of Mindfulness.

Everyone welcome.

Note: Please bring food for the day, e.g. breakfast and lunch. Coffee and tea provided.

Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email
Your answer
Emergency Contact *
Your answer
Have you attended sesshin or meditation retreat before? If yes, when and where?
Your answer
Do you have any special medical/physical/psychiatric conditions that may affect you during retreat? (Please give details this is confidential for the teachers information in order to support you in the retreat) e.g. pregnancy, back pain, mental health issues. *
Your answer
Please list any medications you are taking and any food intolerances:
Your answer
Payment Details
PLEASE MAKE PAYMENT TO:

DZG
BSB 035-302
ACCOUNT 29-7241

AND EMAIL RECEIPT TO darwinzengroup@gmail.com with this completed form to complete your registration and save your place.

Payment Made *
I, the undersigned, hereby agree to hold Darwin Zen Group and its members and Teacher, and the Buddhist Society of the Northern Territory not liable for any loss, damage or injury arising directly or indirectly from my participation in this retreat, which may require me to take part in such activities moving equipment or cleaning or leaving my car unattended. I have made sure that I fully understand the nature of a meditation retreat and certify that I am of sound mind and body. *
Required
Note
PLEASE BRING VEGETARIAN LUNCH AND BREAKFAST IN COOL BAG, HAT, WATER BOTTLE YOGA MAT OR SARONG PLEASE NOTE TEA/COFFEE FRUIT ETC PROVIDED. PLEASE ARRIVE 5.30 TO SETTLE INTO YOUR PLACE.

PLEASE MAKE PAYMENT TO DZG BSB 035-302 ACCOUNT 29-7241 AND EMAIL RECEIPT TO darwinzengroup@gmail.com with this completed form to complete your registration and save your place.

PLEASE NOTE THIS IS A NON-SMOKING VENUE. IT IS NOT POSSIBLE TO LEAVE AND SMOKE AND RETURN TO THE MEDITATION HALL AS THIS DISTURBS OTHERS.


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