Application Form of 5-Day Retreat by Ven. Chi Chern繼程法師的禪五

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You are registering for 5-Day Retreat led by Ven. Chi Chern (September 4-8, 2013).
Please filled out the application form correctly.

Retreat begins: Wednesday, September 4, 2013 at 10 a.m., check-in:9 a.m.-9:45 a.m.
Retreat ends: Sunday, September 8 at 12 noon

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

Lansing Buddhist Association

Name

Lodging

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

Male: floor of meditation hall

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

Commute: please return to the center at 5:30am

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Address

Please include street, city, and state.

Phone Number

E-mail

Gender

Male

Female

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Ages

Occupation

Emergency Contact Name and Phone Number

Fee: suggested donation $150

Yes, I would like to make a donation

No, Thanks.

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Do you have a 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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