Registration for Retreat

 

禅修报名表格

 
 
Personal Particulars 个人资料
English name 英文姓名 (as shown in NRIC/passport) *
English name 英文姓名 (as shown in NRIC/passport)
Gender 性别 *
Language 语言 *
Fasting 断食
Food will be provided during break fast to resume eating and detoxification. 断食一日后,会提供食物给参与者复食与排毒。
I would like to join fasting. 我想参加断食。 *
Health Status 健康状况
Any history of asthma? 是否有哮喘的历史? *
Any history of mental illness? 是否有精神疾病方面的历史? *
Emergency Contact 紧急联络
Payment 付款
Please make the payment at least 1 week before the retreat. 请提前一星期付费。 For Cashless payment, please use the correct reference number indicated below while making payment. 选择无现金付费者,请在付费时用以下正确的编号。 [21 - 22/9/2019] - Weekend Zen Meditation & Fasting Retreat 禅修断食生活营 Reference No. 编号: 210919RETREAT
Payment Method 付费方式
Declaration 声明
Checkbox *
I hereby declare that the above information is true and am willing to abide by the Organizer's advice and the Zen Centre's regulations. I also understand that the Organizer will not be responsible for any injury incurred during the activity, and also agree to the usage of photos taken during the activity by the organizer. I also agree to receive emails from the organizer. 谨此表示以上所填写內容属实, 我愿意遵守观音禅林的规定及负责人的指示。我同意在活动期间若出现任何意外, 观音禅林将无需承担任何责任。我也同意主办单位用当天所拍到的照片。我也同意主办单位发送电子邮件给我 。