Meditation Retreat To Be Conducted by Venerable Dhammajiva Thero
7th to 16th June 2017
Registration of Participants. Closing Date:10th of March 2017.
(Registration Deposit of $50.00 to be paid prior to registration)

Please read NOTES on the right before filling the Form.
Primary Applicant may only add close family members: spouse and children.

Already Registered: 81

Available Positions: 0

Maximum reached. New Registrants will be wait-listed.

(1) Primary Applicant's First Name:
  • Please deposit $50.00 prior to registration and enter your your name, Deposit date and Bank Transit Number in the 10th field of this Form. Deposit to be made to TD Bank, Account No. 1074-5038282, Account Holder: Dhamma Retreat.
  • If other family members (spouse or children) are participating please enter the total number against 'Total Participants' in the 6th field and their names and dates against 'Participant Names..' in the 9th field.
  • 7th Field: If you need accommodation close to Mahavihara, please enter the number of persons requiring accommodation and indicate whether you need shared or single room.
  • 8th Field: Please select your seating preference: cushion or chair. Chairs will be placed at the back or sides of the Hall.
  • 9th Field: If you intend attending full meditation period (7th to 16th June), enter 'Full Period' else enter the relevant dates 7th, 8th etc. against 'Participant Names..'
  • 11th Field: Please enter Name and Tel.Number of a person to contact in case of an emergency.
  • 12th field: Security Number is to avoid potential for misuse of this form. If it is not clear please refresh page.
  • For more information please contact the Organizing Committee by E-mail:
  • Thank you for taking time to register.
(2) Primary Applicant's Last Name:
(3) Email:
(4) Telephone:
(5) Full Mailing Address:
(6) Total Participants:  
(7) No. of Persons Requiring Accomodation:        Shared Room:    Single Room:
(8) Seating Preference:  
(9) Participants Names, Dates and Remarks:
Please Enter 'Full Period' or dates of partcipation with names.
(See Notes on the Right)
(10) Registration Deposit ($50.00)
Enter Your Name, Bank Transit No. &
Deposit Date (dd/mm/yyyy):
(11) Emergency Contact Name & Tel.:
(12) Enter Verification Number        Verification No:⇛ (Refresh page if not clear)
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