Registration Form for Meditation Retreats
Name: __________________________________________ Phone: _______________________
Address: ________________________________________ E-Mail: _______________________
Date Arriving: ___________________________ Time of Arrival: _________________________
Date Leaving: ____________________________ Time of Departure: _____________________
Name of Group Retreat (if applicable): _____________________________________________
Dorm Room? __________ Single Room (If available)? _____________ Tent? ____________
I will stay elsewhere and only attend classes/meditation sessions (Let us know if you will join
the group for Oryoki meals.) _____________________
Which facility do you wish to reserve for a private retreat?
Chalet: _____________ Yurt (Dharma Protector Chapel: _____________ Tent: __________
Any food allergies or special needs?
Please e-mail the above information to firstname.lastname@example.org. If a unit meeting your requirements is available, we will inform you and the deposit required to hold the unit. Please note that there can be absolutely NO fires or lights in the Dharma Protector Chapel and certain dharma rules must be observed.
Special Requirements to Take a Long-Term Retreat:
Please attach a brief summary of your reasons for taking a long-term retreat and a letter of recommendation from your Vajra Master that indicates your readiness for such a retreat and includes his/her phone number and/or email.