Application Form of 2-Day Retreat by Dr. Rita Gross

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You are registering for the 2-Day Retreat led by Dr. Rita Gross
Please filled out the application form correctly.

Saturday May 3, 2014, 10 a.m. - 9 p.m., check-in: 9-9:45 a.m.
Sunday May 4, 2014, 6:30 a.m. - 4 p.m.
Fee: $60 donation (student $30)

Thank you for joining us in growing a peaceful and joyful community.

Lansing Buddhist Association

Name

Address

Phone Number

Occupation

Gender

Male

Female

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Emergency Contact Name and Phone Number

E-mail

Ages

Lodging

Please bring your own sleeping bag and/or air mattress/pad.

Male: floor of meditation hall

Female: floor of Jing Ye Ju (f.k.a. Perry House)

Commute: please return to the center at 6:30 a.m. on Sunday, 5/4

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Fee

$60 donation

$30 donation (student)

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Do you have any medical condition that needs attention?

Yes: Please inform the retreat organizer before the retreat.

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Have you studied meditation before?

Yes

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If yes to the question above, in what tradition?

How many years have you been practicing?

Note

By checking the following box, I agree to relieve Lansing Buddhist Association from all liabilities in the event of any injury or illness incurred while I am on the retreat center property.

Yes

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Submit

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