Hanamatsuri Five-day Retreat 2016

Please Register/RSVP by filling out this form by Wednesday, March 30th, 2016. E-mail us here if any trouble with registering online. Thank you!

Full Name *

Gender

M

F

Contact Number

Email Address *

Address

Total number attending Lunch including yourself (Required)

Suggested Donation (required) * $300 Five-day Sesshin (pay by Paypal) $325 Sesshin & Ceremony (pay by Paypal) $25 Ceremony & Lunch Make Donation by Check on the day of Service and/or Sesshin Make Donation by Cash on the day of Service and/or Sesshin

Participation Information & Room Assigment (required)

I need airport pick-up ($10)

I need housing

I snore loudly

I need to rent linens ($5)

I commute from home

I participate part-time

For housing, please indicate expected date & time of your arrival & departure.

For part-timer, please indicate expected time & day you'll be participating

Previous Experience for FIRST-TIMER

I have sat Sesshin before

I am currently studying with a Dharma Teacher

I am new to Sesshin and need an instruction

If clicked, briefly describe your previous experiences including practice centers:

Medical/Emergency Information for FIRST-TIMER (Required)

Have you recently had symptoms of headache, dizziness, palpitation, or shortness of breath associated with practicing meditation?

Yes

No

Are there any current physical, psychological, medical or other conditions that may affect your participation in retreat?

Yes

No

Do you have an dietary restrictions and/or allergies?

Yes

No

If you clicked yes above, please specifically indicate the conditions