Retreat Registration 閉關報名表

Language 語言 (required)

Gender 性別 (required)

First and Last Name 英文名字及姓氏

Chinese Name 中文名, 請以中文填寫

Year of Birth 出生年份 (required)

Country Calling Code 國家長途電話區號 (required)

Telephone No. 電話 (required)

E-mail 電郵 (required)

Address 地址 (required)

Photo 相片

Please submit a file not larger than 500 kBytes. Acceptable file types are: jpg, jpeg, png, tiff, bmp.
請上載個人大頭照片一張,檔案不能大於 500 kBytes。


Religious Affiliation or Group 所屬宗教團體 (if any 若適用); Optional for non-Buddhists 非佛教徒可不填寫

Have you taken refuge in the Buddha? 是否已皈依?(required)

          If yes, please give the year you took refuge 若已皈依,請填寫皈依年份

          If yes, are you a monastic, Master of Dharma Listening Session or a Rinpoche? 你是否僧人、聞法上師或仁波且?

          If yes, please give the name of your refuge master 皈依師

          If yes, please provide your dharma name, if you have one 法名

          If yes, do you have a refuge certificate/booklet that contains your daily practice? 你是否有皈依證用作每天修持?

          Refuge Location (City, Province, Country) 皈依地點 (城市,省份,國家)

          If no, do you wish to take refuge with Zhaxi Zhuoma Rinpoche? 你是否希望扎西卓瑪仁波且爲你舉行皈依?

Do you wish to receive dharma from Zhaxi Zhuoma Rinpoche? 你是否希望向扎西卓瑪仁波且求法?

          If yes, which dharmas have you received? 求法者需填寫,你至目前為止已經接了什麼法?

          If yes, which dharmas do you wish to receive? 你希望求什麼法?

Do you wish to request an interview with Zhaxi Zhuoma Rinpoche for any other reason? 你是否有其他事希望求見扎西卓瑪仁波且?

          If yes, what is the reason for the interview? 請略為說明求見仁波且的原因?

Experience in meditation 禪修經驗

Do you have any food allergies? If you have, which ones? 有沒有食物過敏? 若有,請說明。

Emergency Contact 緊急聯絡人

Name 姓名 (required)

Country Calling Code (required)

Telephone No. 電話 (required)

Deposit 預留名額訂金: $100美元

The deposit is to hold a bed for you at the temple. Registration accepted on a first come basis. Registration deposit is non-refundable unless someone else fills your spot. There are only ten beds available in dormitory rooms and one single room in a separate cabin. Tent sites are also available, but you would need to bring your own cot and bedding. Suggested donation per night to cover cost of food, utilities, and the like is $35. Monastics and those unable to pay this amount may request a discount. Those who can afford to pay more may do so to cover the cost of these discounts.

You will be automatically redirected to Paypal after registration. To complete your registration you will need to pay the retreat deposit using Paypal. If you cannot use Paypal, please contact the temple at +1 (626) 375-6328
填妥表格後,將直接連到「貝寶」網站,繳交訂金後正式完成報名。若不用貝寶,請致電寺廟 +1 (626) 375-6328