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: 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)
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