Notice: Use of undefined constant cha - assumed 'cha' in /home/hg82w563pu0e/public_html/retreat/Registration2.php on line 446

Notice: Use of undefined constant php - assumed 'php' in /home/hg82w563pu0e/public_html/retreat/Registration2.php on line 446

Meditation Retreat To Be Conducted by Venerable Welimada Jinalankara Thero
28th to 30th November 2019
Registration of Participants. Closing Date:25th of November 2019.
(Participation Fee of $25.00 to be paid on 28th November 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: 17

Available Positions: 33

Tentative Registration Closing Date:
25th November 2019
(1) Primary Applicant's First Name:
    NOTES
  • Participation Fee of $25.00 to be paid on the first day of meditation, to cover the utility expenses of Mahavihara.
  • 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 8th field.
  • 7th Field: Please select your seating preference: cushion or chair. Chairs will be placed at the back or sides of the Hall.
  • 8th Field: If you attend full meditation period, enter 'Full Period' else enter the relevant dates 22nd, 23rd etc. and seating preference against 'Participant Names..' together with the names of any family members.
  • 9th Field: Please enter Name and Tel.Number of a person to contact in case of an emergency.
  • 10th 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) Seating Preference:  
(8) Participants Names, Dates and Remarks:
Please Enter 'Full Period' or dates of partcipation with names.
(See Notes on the Right)
(9) Emergency Contact Name & Tel.:
(10) Enter Security Number Security Number:⇛ 
         Report Entry Issues
 Click this Button if above Security Number is not clear: