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Free Sunday Meditation and Cultivation Class


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Applicant Details


First Name *

Surname *


Gender  *

Date of Birth *
   Please select YEAR first

Education Qualification
   Reference Description
 *


Contact Details

Address  *
Street No.  * Street Name  * Suburb  *
State/Territory  * Postal Code  * Country  *

Mobile. * Email *

Class Details:


Class Dates (at least one class date is needed): *


Have you participated in any courses/retreats at Nan Tien Temple before?  *
  Please specify   *
    Have you read any books in Buddhist Studies?   

Remark

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.?   

2. Do you have or ever had any mental health problems; e.g. significant depression, anxiety, panic attacks, schizophrenia etc.?   

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?   

Media Policy Agreement


Fo Guang Shan Nan Tien Temple reserves the right to take photographs, images, video, or audio recordings of the classes and activities during the event for temple records, website and future publications.

By choosing 'Yes' it indicates that you have fully read, understand, and agree to the terms of the above "Media Policy Agreement" in its entirety and also give your consent to use your image in temple publications.


*

Declaration


  I hereby declare that:
  1. The information I have provided in this application is true and correct, and I will notify Nan Tien Temple of any change.
  2. 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.
  3. I take full responsibility and liability for my own health and safety, including any accidents, risks, or "acts of nature" during the retreat/course.
  4. I have read and agree to the Refund Policy and the Privacy Policy.

Confirmation




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©Copyright 2021 Fo Guang Shan Nan Tien Temple, Australia, All rights are reserved.
E-mail: info@nantien.org.au Phone: +61 (2) 4272 0600
Address: 180 Berkeley Road, Berkeley, NSW 2506 Mail: PO Box 1336, Unanderra, NSW 2526