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2020 BLIA Eight Precepts Retreat Application 佛光會八關齋戒修道會報名表
Event Date + Time: SAT 3/28 8:00am to SUN 3/29 9:00am
Check In is on 3/28 between 8:00am to 8:30am only

**NOTE: If you are NOT a current BLIA member, you will automatically be WAITLISTED and notified if there is space open about 1 week prior to the event. Please accept our apologies for any inconvenience this may cause. Thank you!  

**If a valid email address has be entered, you will receive a receipt in your email In Box virtually immediately.

**An email will be sent about one week prior to the event to confirm your attendance.


活動日期+時間：3/28 (六)早上8:00 至 3/29 (日) 早上9:00
報到時間：3/28 早上8:00 至 8:30之間

 **備註：如果您不是國際佛光會會員，我們會將您的報名表列入候補名單，活動前一週再通知有沒有名額。不便之處，敬請諒解。謝謝！

**若email有正確輸入，報名完畢會即刻收到一份報名收據。

**活動前一週會寄email，請務回覆以確認名額。


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Email *
BASIC INFORMATION 基本資料
1a) FIRST Name *
名字英文拼音
1b) LAST Name *
姓氏英文拼音
1c) 中文姓名
(Chinese name if available)
2) Gender 性別 *
3a) Birth Year 出生年份 *
(Please use YYYY format. 請用西元、四位數字)
3b) Age 年齡 *
4) Language 使用語言 *
(Choose the language you understand best. 請選擇您的母語)
5a) Height 身高 (尺' 吋") *
(Please use feet' inches" measurements - for uniform preparation. 準備修道服用)
5b) Weight 體重 (磅 lbs.) *
(Please use pound [lbs.] measurement - for uniform preparation. 準備修道服用)
6) Educational Background 學歷
Clear selection
7) Occupation 職業
CONTACT INFORMATION 聯絡資料
8a) Email Address 電郵地址 *
 ( This is the main form of communication; please check for accuracy. If you cannot be contacted, your seat will be forfeited. 一般聯繫以email為主，請務必確認正確。活動前，若無法與您聯繫或得不到您的回應，名額將讓給他人。)
8b) Announcements 活動資訊 *
(Once a month at most or for special events. 大約一個月寄一次，或重要活動提醒)
9) Contact Number 聯絡電話 *
 (ex: 6269619697 , 10 digits, no punctuation please )
10) Home Address 住家地址
11a) EMERGENCY CONTACT - First & Last Name 緊急聯絡資料 - 姓名 *
(Someone NOT in the retreat. 非一同參加本活動之學員)
11b) EMERGENCY CONTACT - Relation 緊急聯絡資料 - 關係 *
(How do you address this person? 您怎麼稱呼這位?)
11c) EMERGENCY CONTACT - Phone Number 緊急聯絡資料 - 電話 *
 (ex:626-961-9697)
MEDICAL CONDITION 健康狀況
12a) Medical Condition 健康狀況 *
 (Please answer truthfully and check all that apply. 請誠實作答並勾選所有相關項目。)
Required
12b) Current Medications 目前服用藥物 *
 ( OTC and prescription drugs. 含處方藥 以及 非處方藥)
12c) Are you allergic to ANY drugs, foods, or insect bites? 您對任何藥物、食物、或昆蟲叮咬過敏嗎？ *
12d) Could your snoring disturb other roommates? 您是否有因打鼾而可能干擾到同寮房之人的可能性？ *
RELIGIOUS BACKGROUND / EXPERIENCE 宗教背景 / 經驗
13a) BLIA Subchapter「國際佛光會」 會員 所屬分會 *
13b) Who is your subchapter president? 您所屬分會會長的大名？ *
14) Temple Regularly Attended 親近道場
What spiritual center do you normally go to? 您平時親近哪間道場？
15a) Refuge/Precepts 戒別 *
(Choose n/a if you have not taken refuge yet. 未皈依者請選 n/a)
15b) Dharma Name 皈依法名
(Please enter n/a if you have not taken refuge yet. 未皈依者請輸入 n/a)
16) How many times have you attended the Eight Precepts Retreat? 『八關齋戒』參加了幾次？ *
17) Where did you hear about this event? 您從那裡得知此項活動之訊息? *
PARTICIPANT AGREEMENT / TERMS OF STAY 參與者同意/住宿條款
18a) INTERNATIONAL BUDDHIST PROGRESS SOCIETY EVENT PARTICIPATION AGREEMENT : I declare that I am in good physical health and that I am able to participate in the “F.G.S. Hsi Lai Temple Eight Precepts Retreat” held from 3/28 to 3/29/2020. However, if I should experience any physical or health problems during the event and I am unable to continue, I will leave voluntarily. If medical care is required for any illness that may occur, I will be fully responsible for the charges. Should any accident occur due to my own negligence or intentional act or any undiscovered sickness that I may have during the event, I will be solely responsible and will not hold the organizer, International Buddhist Progress Society (Fo Guang Shan Hsi Lai Temple) or any of its employees or volunteers liable. During the event, if I experience any extraordinary physical conditions which interfere with the practice of other participants, I will  accept the directions of the organizer and leave the retreat without dispute. 佛光山西來寺參與活動同意書：本人參加西來寺於2020年3月28日至29日所舉辦的「佛光山西來寺八關齋戒修道會」活動，於此聲明本人之健康情況良好，於活動期間若感身體不適，無法繼續，願自動退出；若因疾病需就醫治療時，願自行負擔全額醫療費用。 於活動期間，如因個人疏失、或因個人故意行為、或因本身原有隱疾，而發生意外時，本人願擔負起一切責任，主辦單位及服務人員不負任何責任。 於活動期間，如因個人身體狀況而引發異狀，因而干擾他人修道時，本人願接受主辦單位指示，自動出堂，無有異議。
E-Signature 電子簽名 *
Please type your name below to acknowledge agreement to the terms of participation. 請在此輸入您的大名以同意以上參與者同意書 。
MEDIA AGREEMENT 媒體同意
18b) INTERNATIONAL BUDDHIST PROGRESS SOCIETY MEDIA POLICY: International Buddhist Progress Society (Fo Guang Shan Hsi Lai Temple) reserves the right to take photographs, images, video, or audio recordings of any and all classes and activities during the event for temple records, website and future publications. 佛光山西來寺媒體政策同意書：活動期間，主辦單位會拍照或攝錄，用於寺內的活動記錄、網頁及刊物中。
E-Signature 電子簽名 *
Please type your name below to acknowledge agreement to the media policy. 請在此輸入您的大名以同意以上媒體同意書 。
QUESTIONS, COMMENTS, CONCERNS 疑問或意見
19) Anything you would like us to know or have concerns about? 您有任何疑問 或 事情需要告訴我們的嗎？
A copy of your responses will be emailed to the address you provided.
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