Nan Tien Temple

Meditation (Intermediate) Online Registration

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Applicant Details

First Name *

Last Name *

Gender *

Date of Birth *

(Please select Year first)

Education Qualification
Reference Description

Occupation Classification *

Occupation Sub-classification

Contact Details

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Street No. * Street Name * Suburb *

State/Territory * Postal Code * Country *

Mobile * Email * Fax

Course Details (Special Offer $70 for booking both Buddhism and Meditation class)

Course A *

Course B (Optional)
( ** Course B is optional. Take Buddhism and Meditation class during the same term, a discounted fee of $70 is payable. )

Term *

Payment Method

Additional Information

Please answer the following questions.
Please give details if you answer "Yes" to the following questions; (type, frequency, amount etc.)
All information will be kept strictly confidential. Thank you for your co-operation.

1. Do you have or ever had any physical health problems; e.g. Diabetes, heart disease, epilepsy etc.? Yes No

2. Do you have or ever had any mental health problems; e.g. significant depression, anxiety, panic attacks, schizophrenia etc.? Yes No

3. Are you now taking, or have you taken any drugs in the past two years; e.g. Barbiturates, cocaine, amphetamines, alcohol, marijuana or other intoxicants?
Yes No

* Pregnant women are advised to consult their Doctor before joining Tai Chi. We cannot accept any responsibility as complications may arise.
* Payment in full, plus application form is required a week before courses commence.
* NO REFUND or TRANSFER after commencement of course.

Dressing Code

Please wear appropriate attire and be suitably covered i.e. no shorts, singlets or thongs.

Here at the Temple we implement the practice of noble silence during our meditation retreats. This practice assists in creating an environment conducive to the development of awareness, attentiveness and compassion.

What is Noble Silence?
Noble Silence means no talking or non-verbal communication, except in emergencies or discussion times with the Reverend/Teacher. The practice of Noble Silence assists us in clearing the clutter within our minds, creating a calm environment, and is an essential foundation for the powerful inner work our meditation retreats facilitate.

Media Share Consent

By choosing 'Yes', this indicates that you give us consent to use your photographs, images, video, or audio recordings of the classes and activities for temple records, website and future publications. Yes No *

Declaration

I hereby declare that:

The information I have provided in this application is true and correct, and I will notify Nan Tien Temple of any change.

I have read all the information related to this retreat/course, and accept and agree to all of its Terms and Conditions. I agree to abide by Nan Tien Temple's policies and procedures for the duration of the retreat/course.

I take full responsibility and liability for my own health and safety, including any accidents, risks, or "acts of nature" during the retreat/course.

I have read and agree to the Refund Policy and the Privacy Policy.

Confirmation

* I acknowledge that it is a condition of my application that I have read, understood, acknowledged and agreed to the above declaration.

©Copyright 2019 Fo Guang Shan Nan Tien Temple, Australia, All rights are reserved.
E-mail: info@nantien.org.au Phone: +61 (2) 4272 0600 Fax: +61 (2) 4272 0601
Address: 180 Berkeley Road, Berkeley, NSW 2506 Mail: PO Box 1336, Unanderra, NSW 2526