Cittamani Tara Retreat

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1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Email* Phone* Address* Address Address 2City State/Prov. Zip/Postal Country * Email newsletter I would like to receive Vajrapani Institute's email newsletter! Dietary Restrictions* Write none if none. Please list any medical conditions (e.g., Celiac disease) that affect your diet. Please note that the kitchen cannot accommodate all dietary preferences. Please refer to the website's FAQ for information specific to this topic. Special Diet* All meals served at Vajrapani Institute are vegetarian. Emergency Contact Info* Please list name and phone number. Medical Issues* Enter "none" if you have no conditions or issues Are you an ordained monastic?* No Yes Let us know if you would prefer a chair or a cushion in the gompa for your seating arrangement.*
Guest 1		First Name* Last Name* Email* Phone* Address* Address Address 2City State/Prov. Zip/Postal Country * Email newsletter I would like to receive Vajrapani Institute's email newsletter! Dietary Restrictions* Write none if none. Please list any medical conditions (e.g., Celiac disease) that affect your diet. Please note that the kitchen cannot accommodate all dietary preferences. Please refer to the website's FAQ for information specific to this topic. Special Diet* All meals served at Vajrapani Institute are vegetarian. Emergency Contact Info* Please list name and phone number. Medical Issues* Enter "none" if you have no conditions or issues Are you an ordained monastic?* No Yes Let us know if you would prefer a chair or a cushion in the gompa for your seating arrangement.*

4 Participant Info

Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Email newsletter	I would like to receive Vajrapani Institute's email newsletter!
Dietary Restrictions *	Write none if none. Please list any medical conditions (e.g., Celiac disease) that affect your diet. Please note that the kitchen cannot accommodate all dietary preferences. Please refer to the website's FAQ for information specific to this topic.
Special Diet *	All meals served at Vajrapani Institute are vegetarian.
Emergency Contact Info *	Please list name and phone number.
Medical Issues *	Enter "none" if you have no conditions or issues
How did you hear about us? *
Are you an ordained monastic? *	No Yes
Where were you ordained? Who were you ordained by?
Let us know if you would prefer a chair or a cushion in the gompa for your seating arrangement. *

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