Name
Age: Male Female
Address:
City:
State: Zip/Postal Code:
Phone:
E-mail:
Are you a ZCO/DRZC member currently paid-up on your dues?
Yes No
Please briefly describe your meditation experience.
How did you hear about us?:
Do you have any food allergies?
If yes please list the foods you are allergic to:
Do you have any other health concerns we should be aware of?
Please list your skills (we are particulary interested in plumbing, carpentry, painting, other construction skills, gardening/landscaping, sewing, and cooking).
Emergency contact information
Name of person to contact in case of emergency:
Relationship:
Daytime phone: Evening phone:
I am willing to be a carpool contact.
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.
Zen Community of Oregon P.O. Box 368 Clatskanie, OR 97016 (503) 728-0654 Email: info@zendust.org