Queensland Zen Centre
Home
Teachers
Essence of Mind
Dharma talks
Schedule
Information
Membership
Retreats
Expression of interest
Gallery
Contact us
Retreat Application Form
Important: please read the
retreat information page
before submitting this application form.
*
Indicates required field
Name
*
First
Last
Date of retreat
*
Please specify which retreat you would like to attend
Medical information
*
Please provide details of any medical condition or allergies that may impact on your participation in the retreat, with details of any medical management strategies or medication needs that we should be aware of.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Training/practice experience
*
Please provide details of your previous meditation training/practice experience, and the length and year of any retreat you have participated in
Teacher/tradition
*
Please provide details of which tradition/s you have practiced in and any teachers you have practiced with
Current place of practice
*
If you are currently a member of a Buddhist or other meditation group, please provide details here
Email
*
Phone Number
*
Emergency Information Contact
*
Please provide a name and contact number in case of an emergency.
Referee
*
If you have not sat with us before, please provide contact details for a teacher or sangha member who can speak to your practice experience
Please note
: All information provided is kept strictly confidential and will be reviewed by Zen Master Senshin. Notification by email will be sent to every applicant.
Submit