Queensland Zen Centre
Home
Teachers
Essence of Mind
Dharma talks
Schedule
Information
Fundraising Appeal 2024
Membership
Retreats
Gallery
Contact us
Retreat Application Form
*
Indicates required field
Retreat dates
*
Please specify which retreat you are interested in.
Name
*
First
Last
Email address
*
Phone number
*
Medical information
*
Please provide details of any medical condition that may impact on your participation in the retreat.
Medical management
*
Please let us know of any medical management plans you have in place to manage your medical condition.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Training/practice experience
*
Please provide details of your previous meditation training/practice experience
Current place of practice
*
If you are currently a member of a Buddhist or other meditation group, please provide details here
Please note
: All information provided is kept strictly confidential and will be reviewed by Zen Master Senshin.
Information you provide will never be shared with third parties without your express consent. Your information will be stored securely, and disposed of, in accordance with the Australian Privacy Principles.
Medications
*
Please provide details of any medications we should be aware of.
Allergies
*
Please advise of any allergies that we should be aware of.
Teacher/tradition
*
Please provide details of which tradition/s you have practiced in and any teachers you have practiced with
Retreat experience
*
Please provide details of your retreat experience - teachers, length of retreats, year
Emergency Contact
*
Please provide a name and contact number in case of an emergency.
Submit