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Event Registration

Please fill out a separate registration form for each person you would like to register.  

Event Name: Awakening to the Heart of Wisdom

Participant Name (first, last, dharma name)  

Age:        

Address:

City:

State:    Zip/Postal Code:

Phone:

E-mail:

 

 

Would you like meditation instruction?

 

Food allergies or health concerns we should be aware of: (please type "No food allergies" 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.

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

©2006 Zen Community of Oregon
Updated: March 20, 2009
Site by Michelle Bagley