*Please submit one form per person

Name: ___________________________________ Ordained Nun: __ Ordained Monk: __

Mailing Address: ___________________________________________________________

Email Address: ______________________________________

Phone: _________________

If arriving late, please enter an estimated date of arrival: ______________

If lunch is provided, I would like to participate: Non-vegetarian __ Vegetarian __

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Sangha Only:
I will need financial assistance for rent at Deer Park:
Full __ Partial __

I will need financial assistance for lunch, if provided:
Full __ Partial __
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Amount Enclosed:

Course Deposit ________ (minimum $150)

Full Payment ________ ($300)

Donation for Sangha ________ (to help Sangha pay for housing at Deer Park and lunch)

Other ________ Purpose: ______________________________________________

TOTAL ________

THANK YOU