The House of Dhamma

Application Form

 

Name and date of the course

Mr/Mrs/Miss and Name

Surname

Permanent address

Tel

E-mail address

Temporary address in Thailand

Tel.

Mobile phone

Date of birth

Nationality

Passport or ID number

Occupation

Name and address of a person to contact in emergency

Have you practised Vipassana meditation before? yes no

How long have you practised Vipassana meditation?

Have you practised other forms of meditation? yes no

If so please give details

For YBAT retreats, do you wish to book a place in the minivan? Yes No

Please send e-mail at least 7 days before the course begins.