Meditation Retreat To Be Conducted by Venerable Uda Iriyagama Dhammajiva Thero
18th to 27th June 2019
Registration of Participants. Closing Date:31st of Jan. 2019.

Please read NOTES on the right before filling the Form.
Primary Applicant may add close family members: spouse and children in Box 8.

Already Registered: 61

Available Positions: 19

Tentative Registration Closing Date:
31st January 2019

(1) Primary Applicant's First Name:
    NOTES
  • If other family members (spouse or children) are participating please enter the total number against 'Total Participants' in the 6th field and their names,dates and seating preference 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, enter 'Full Period' else enter the relevant dates 22nd, 23rd etc. and seating preference against 'Participant Names..'
  • 10th Field: Registration Fee of $50.00 per person required to meet initial expenses. Pl. deposit this amount as per our e-mail sent earlier.
  • 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.
  • 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 Fee ($50.00 per person)
Enter Your Name, Bank Transit No. &
Deposit Date (dd/mm/yyyy):
(11) Emergency Contact Name & Tel.:
(12) Enter Security NumberSecurity Number:⇛ 
         Report Entry Issues
 Click this Button if above Security Number is not clear: