The 61st 7-Days Meditation Retreat Online Registration Form (For Monastics only)

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【Part 1】：Remittance Slip

1.01 Course Title

1.02 Please upload the【remittance slip】

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1.03 Please upload a【headshot】:

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【Part 2】：Ordination Details

2.01 Dharma Title

2.02 Secular Name

2.03 Date of Ordination

2.04 The Dharma Title of the Ordaining Master

2.05 Ordination and Monastic Residency

2.06 Date of Full Ordination

2.07 The Dharma Title of the Preceptor

2.08 Precept and Monastic Residency

【Part 3】：Personal Info

3.01 Day of Birth

3.02 Gender

3.03 Mailing Address (House Number, Street Name, Residential Area, Postcode, County / City)

3.04 States / Provinces

3.05 Country

3.06 Mobile Number

3.07 NRIC / Passport

3.08 Email Address

3.09 Position / Role

3.10 Organization / Dharma Center

【Part 4】：Buddhist Learning Journey

4.01 In which year did you begin study Buddhism?

4.02 Dharma Name

4.03 Referring Master for Refuge Certification

4.04 Have you ever learned seated meditation?

4.05 If so, who was your mentor?

4.06 Where, when and which type of meditation course have you studied?

4.07 Do you need to re-learn the method?

4.08 Do you practice regularly on weekdays?

4.09 If applicable, how do you schedule your practice time?

4.10 Which Buddhist organization are you currently active in?

4.11 What position do you hold in the organization?

4.12 Which Buddhist books have had the greatest influence or inspiration on you? (max. 40 words)

4.13 Which Buddhist courses and group practice activities have you participated in? (max. 40 words)

4.14 What is your motivation and objective for participating in the intensive Chan meditation retreat? (max. 40 words)

4.15 Briefly describe your reflections after studying the Dharma and practicing seated meditation (max. 40 words).

【Part 5】：Health Status

5.01 Health: Do you have any physical illnesses, eg. diabetes, heart disease or others? If any, please state details.

5.02 Psychological: Do you have any emotional/psychological illnesses, e.g. anxiety, depression? If any, please state details.

5.03 Are you currently on any medications? If any, please state the type(s) of medication and intake routine(s).

5.04 If necessary, Please attach an enclosed letter to our Retreat Master.

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【Part 6】：Info of Emergency Contact

6.01 Emergency contact

6.02 Emergency contact number

6.03 Relationship to Emergency Contact

【Part 7】：Signature & Declaration

7.01 I declare that the information provided is accurate and complete.

7.02 I commit to observing all course rules during my stay.

7.03 I am solely responsible for my own physical and mental health issues

7.04 Date of Signature

【Part 8】：Please fill in the CAPTCHA

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