Please fill out this registration form for you and your partner.
Your Name:
Your Partner's Name
(information about age and gender helps us with room assignments)
Your Age:
Your gender: Male Female
Your partner's age:
Your partner's gender: Male Female
Address:
City:
State: Zip/Postal Code:
Phone:
E-mail:
Would either of you like meditation instruction? Yes No
Food allergies or health concerns we should be aware of:
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