Kwan Um Zen Europe | Application Form

Kyol Che, Warsaw

Family Name^*		Gender^*	Female Male
Personal Name^*			Female Male

Street^*		Number
City^*		Postcode^*
Country^*
Telephone		Cellphone
Email Address^*

Person to contact in case of emergencies:
Name^*
Telephone		Cellphone

Is this your first Zen retreat?		No	Yes
Are you a member of the Kwan Um School of Zen?		No	Yes
	If yes, through which Zen Centre?
	How many precepts do you have?	No precepts Five Ten Dharma Teacher Sixteen Forty-eight Sunim/HJN JDPSN/SSN

Precepts taken:
Dharma Name:
-- in English:

The retreat runs from 19/6/2010 17:00 until 17/9/2010 11:00
Date and time you will arrive: time
Date and time you will leave: time

Do you have any special dietary needs?		No	Yes
If yes, please specify:
Are you currently taking any medication?		No	Yes
If yes, please specify:

	I confirm that I am taking part in this Kyol Che retreat of my own free will. I release the Kwan Um School of Zen and all individuals involved in organizing the Kyol Che from any responsibility or liability regarding my health or other personal issues that could emerge as a result of my participating in the Kyol Che.