Registration of Participants
One-Day Meditation Retreat To Be Conducted
by Venerable Uda Iriyagama Dhammajiva Thero
Wednesday 12th June 2024
Closing Date:8th of June 2024.

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: 26

Available Positions: 24

Tentative Registration Closing Date:
8th of June 2024
(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 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 multiple persons participate, enter name/s, and seating needs against each name.
  • 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 below partcipants' names and seating needs. (See Note 8 on the Right)
(9) Emergency Contact Name & Tel.:
(10) Enter Security NumberSecurity Number:⇛ 
         Report Entry Issues
 Click this Button if above Security Number is not clear: