Retreat Registration 閉關報名表

Seven-day Zen Meditation Retreat, Bangkok, Thailand – December 2-9, 2015

泰國曼谷七天禪修 2015年12月2-9日

Language 語言 (required)

Gender 性別 (required)

First and Last Name 名字和姓氏 (required)

Chinese Name 中文名, 請以中文填寫

Year of Birth 出生年份 (required)

Country Calling Code 國家區號 (required)

Telephone No. 電話 (required)

E-mail 電郵 (required)

Address 地址 (required)

Photo 相片 (required)

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


Religious Affiliation or Group 所屬宗教團體或道場 (if any 若適用); Optional for non-Buddhists 非佛教徒可選擇不填寫

Have you taken refuge in the Three Jewels or Four Jewels? 你是否已皈依三寶或四寶? (required)

          If yes, please give the year you took refuge

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

          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 Venerable Zhaxi Zhuoma? 你是否希望皈依扎西卓瑪尊者?

Do you wish to receive dharma from Venerable Zhaxi Zhuoma? 你是否希望向扎西卓瑪尊者求法?

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

          If yes, what is the reason for the interview? 請略為說明求見尊者的緣起?

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 國家區號 (required)

Telephone No. 電話 (required)

Fees 費用 : $400

All fees include accommodations and meals. It does not include transportation. Participants are required to bring their own meditation cushions. 費用包括住宿及膳食。不包括交通費。參加者請自備座墊。

          Please select check out time: 請選擇離開時間:

Limited to 33 people. Registration accepted on a first come basis. Payment for registration is non-refundable.  

Fee Policy 收費政策:
Registration fee is non-refundable and participation is non-replaceable.

You will be automatically redirected to Paypal after registration. To complete your registration you will need to pay the retreat fee using Paypal.
填妥以上表格後,按 "寄出"後,將會到達貝寶網頁,請以貝寶繳交費用,完成報名手續。