禅修營 Meditation Retreat

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联办单位 Organizer: 护法苑 Nibbana Dhamma Rakkha
导师 Teacher: Ajahn Cagino 永觉比丘

营队日期 Retreat Date: 05-07/09/2014 (星期五- 星期日Friday to Sunday)
报到 Check-in： 05/09/2014 7.00am
离营 Check-out: 07/09/2014, 6.00pm
截止日期Closing Date: 29/08/2014

地点 Venue: 护法苑会所（主办当局会提供住宿）。Nibbana Dhamma Rakkha Premises (stay-in meditation retreat, accommodation will be provided.)

** 提供素食早午餐。Breakfast and vegetarian Lunch will be provided.
** 我们欢迎您护持营队的费用。 Donation is welcomed to support the retreat.
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You will be contacted via email once your application is successful. 成功被录取的报名学员将获得通知。

I) 个人资料 Personal Particulars

1) 姓名 Name *

2) 性别 Gender *

3) 年龄Age *

4) 联络号码 Contact No.: *

5) 电邮 Email: *

II) 禅修经验 Meditation History

1) 参加禅修营的目的 Reason(s) for joining this retreat: *

2) 您有禅修的经验吗？Do you have meditation experience? *

有 Yes

无 No

如有,请说明 If yes, please give details:

禅修方法 / 指导老师 / 禅修年份。 Your Meditation method / Your teacher / Your years of meditation practice.

III) 健康狀況 Health Status

1) 您是否患有以下病症 Are you suffering from: *

心臟病 Heart Disease

胃病 Gastric

肝炎 Hepatitis

糖尿病 Diabetic

高血壓 Hypertension

全无None of the above

Other:

Required

2) 您有被诊断患有任何精神问题？ Have you been diagnosed with mental illness? *

Yes

如有,请说明 If yes, please give details:

病症、何时、是否还在治疗、近期复诊日期 | Type of Diagnosis, Date/Year of Diagnosis, Are you still on medication?

IV) 紧急联络 Emergency Contact

若出現紧急狀況，您的联络人是:
In case of emergency, person to contact:

1) 姓名 Name: *

2) 关系 Relationship: *

3) 联络方式 Contact *

手机号码 HP No.:

住家号码 Home No.:

V) 声明 Declaration

声明 Declaration *

本人在此声明以上所填资料全属真实。在禅修期间，本人将服从导师的教导并遵守道场的所有规定。本人也明白主办团体将不负责任何本人在禅修期间所发生的一切身心健康状况。I hereby declare that the above information I provided above is true and correct. I agree to abide by the Meditation Instructor's advice and the Retreat's rules and regulations. I also understand that the Organizer will not be held responsible for any mental or physical injury incurred during the Retreat.

是，本人亦已阅读及明白以上声明。 Yes, I have read the above declaration

Required

VI) 随缘布施Dana

禅修营费用全免，我们很欢迎您一起加入护持此营队。萨度！萨度！萨度！
This retreat is offered free of charge. However, all donations are welcomed to support the expenses of this Retreat. Sadhu Sadhu Sadhu

我希望布施护持营队 I wish to dana to support the following expenses:-

僧伽四事供养 Sangha Four Requisites

早餐和午餐 Breakfast & Lunch (S$30/pax)

场地 / 水电 Accommodation / Utility (S$2,000)

交通与其他杂费 Transportation and General Expenses

善款数额 Dana Amount (新币SGD)

VII) 其他Others

1) 您希望加入护法苑活动联络网？I wish to be kept informed of NDR activities via email. Please include me in your contact list.

是Yes

2) 备注 Remarks and Comments

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