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Walking Together Registration

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:      

Your partner's age:

Your partner's gender:    

Address:

City:

State:    Zip/Postal Code:

Phone:

E-mail:

 

Would either of you like meditation instruction?

 

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

©2006 Zen Community of Oregon
Updated: February 9, 2010
Site by Michelle Bagley