Buddhist Place Retreat application
May 9 – 11, 2007
Dharma Centre, Kinmount
Name_________________________________ Birth Date____________________________
Street Address_______________________________________________________________
City_____________________________________ Postal or Zip Code ___________________
Phone (home)__________________________E-mail ________________________________
Please indicate if you are fairly new to meditation as well as your familiarity with Buddhist meditation, monastic retreats, and particular traditions.
_______________________________________________________________________
Please provide any information on your physical, emotional, mental health that we should be aware of and that may have an effect on your participation in the retreat. (This will be kept confidential and is for the simple knowledge of the managers and teacher to be aware of any special needs or potential challenges).
If the cost of the retreat is out of reach for you, please indicate amount you are able to offer: _________________________
Cost for the weekend retreat is $150.00. Please make cheques payable to the Buddhist Place with a deposit of $100 (not post-dated) and the balance due at registration (May 9th). Please include payment with registration and mail both to:
Retreat – Isabel Stukator, 248 Wolsely St., Peterborough, ON K9H 4Z6