Please fill out a separate registration form for each person you would like to register.
Event Name (The name of the EVENT you wish to attend)
Participant Name (first, last, dharma name)
Age: Male Female
Address:
City:
State: Zip/Postal Code:
Phone:
E-mail:
Would you like meditation instruction? Yes No
Food allergies or health concerns we should be aware of: (please type "No food allergies" if not applicable)
Please list your skills - we are particulary interested in plumbing, carpentry, painting, other construction skills, gardening/landscaping, sewing, and cooking: (please type "No listed skills" if not applicable)
Emergency contact information
Name of person to contact in case of emergency:
Relationship:
Daytime phone: Evening phone:
I am able to provide transportation for at least one other person wishing to carpool.
I would like to make a donation to the Scholarship Fund to support individuals who are interested in accessing the dharma and deepening their practice.
Please do NOT add me to your mailing list.
How did you hear about us?:
Zen Community of Oregon P.O. Box 368 Clatskanie, OR 97016 (503) 728-0654 Email: info@zendust.org