Rinzai-ki Sesshin Retreat Registration

Please RSVP by filling out this form by Monday, December 30th, 2014. E-mail us here if any trouble with registering online. Thank you!

Hashin-kyuji: Sunday, January 4, 2014
Five day Sesshin: Monday, January 5 to Friday, January 9, 2014
Rinzai-ki Memorial Service: Saturday, January 10, 2014

Full Name *

Gender

M

F

Contact Number

Email Address *

Address

Rinzai-ki Memorial Service RSVP & Registration

Memorial Service only

Memorial Service and Lunch

Service and Retreat

Retreat only

Total number attending Lunch including yourself (Required)

Suggested Donation $450 ($200 Deposit REQUIRED) * $450 Five-day Sesshin by Paypal $200 Deposit by Paypal $200 Deposit Check by Mail

Participation Information & Room Assigment

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

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 sesshin?

Yes

No

Do you have an dietary restrictions and/or allergies?

Yes

No

If you clicked yes above, please specifically indicate the conditions