Registration of Participants
Meditation Retreat To Be Conducted
by Most Ven. Uda Iriyagama Dhammajiva Maha Thero of Nissarana Vanaya
Saturday 13th to Thursday 18th of June 2026
Closing Date:Sunday, May 31st, 2026.

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: 23

Available Positions: 77

Tentative Registration Closing Date:
Sunday, May 31st, 2026
(1) Primary Applicant's First Name:
    NOTES
  • Name, E-mail Address and/or Telephone Number and Postal Address are necessary for our records. They will be held in confidence.
  • 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, dates 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, dates and seating needs. (See Note 8 on the Right)
(9) Emergency Contact Name & Tel.:
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