VESAK RE T R E A T A Mindfulness Retreat with the Monks and Nuns of Magnolia Grove Monastery May 04-06, 2012 Magnolia Grove Monastery, 123 Towles Rd., Batesville, MS 38606 How to Register You may register for the retreat by email or mail. It is best to register before May 1st, 2012 to ensure a place at the retreat. After that date, please email to office@magnoliagrovemonastery.org or call (662) 563-0956 to find out about room availability. All registrations must be received by May 03rd, 2012. Forms receive after May 03rd, 2012 will not be accepted. We kindly ask for your understanding and support. How to fill out the registration form: If you would like to share a room with a specific person, please register on the same form. If you do not specify a roommate, we will assign roommates by gender. For each person in your group or family, print the full name on the form. Please use an extra sheet as needed. Please indicate the age of all participants younger than 18 years of age to help us with housing assignments and to better coordinate the children’s and teens’ programs. We will be sending the confirmation information to the person and address filled out at the top of the registration form. Register by email to: office@magnoliagrovemonastery.org Register by mail to: Magnolia Grove Monastery, Holiday Retreat, 123 Towles Rd., Batesville, MS. 38606 Payment by check or money order, payable to Unified Buddhist Church (UBC). Confirmation: You will receive a confirmation packet in about one week after we have received and processed your registration. Included in the packet will be information about retreat activities and how to enjoy them, as well as other pertinent information. Housing Information: Due to the limited housing at Magnolia Grove Monastery, you can only choose dormitory or camping in the premises of the Monastery. All rooms are 5-10 beds (bunk beds) with public bathrooms. Transportation: Airport: Memphis International Airport (MEM), 56 miles from Magnolia Grove Monastery. Shuttle service from Memphis International Airport to Magnolia Grove Monastery: Please contact Jefferson Travel at (901) 361-4246 to make your own reservation. Please call at least three days in advance.
Public transportation: There is no public transportation available to Batesville, MS. For further questions: Please contact us by email at office@magnoliagrovemonastery.org, or by phone at (662) 563-0956. Our office hours are from 9:00 am-11:30 am Monday through Saturday. Any questions that you might have about the retreat and retreat housing should go to us at the email and number above or leave a message on the answering machine and we will call you back as soon as we can. We look forward to an opportunity to practice together with you.
Vesak Retreat – Registration form – Updated: 04/06/2012
Address: 123 Towles Rd. Batesville, MS. 38606● Tel.: (662) 563-0956 ● Website : http://www.magnoliagrovemonastery.org ● Email: office@magnoliagrovemonastery.org VESAK RET R EA T May 04-06, 2012 Retreat Registration Form Please print the requested information below clearly Name (Last, First ): Address: City:
State:
Zip:
Daytime phone: Email:
Country:
Evening phone: Arrival time: ____________
-Rates: Fees include tuition, accommodations, meals -Housing Information: Due to the limited housing at Magnolia Grove Monastery, you can only choose dormitory or camping. All rooms are 5-10 beds (bunk beds) (a few couple/double rooms available) with public bathrooms. Contributions to build the Meditation Hall: Your generosity makes it possible for the monastery to build a big meditation hall. Any amount would be appreciated. Donations are tax deductible. -People with physical disabilities and/or special needs: Please contact us at (662) 5630956 before registering so we can see how we may support you.
Housing Codes
Accommodation Type (if you do not specify a roommate on this form we will assign you roommates by gender) DORM-A ADULT DORM-S STUDENT (ages 18-26) DORM-T TEEN (ages 13-17 DORM-C CHILD (ages 6-12) COUPLE 2 separate beds with public bathroom CAMP ADULT Please bring your STUDENT (ages 18-26) own tent. TEEN (ages 13-17 CHILD (ages 6-12)
Last name, First name (the contact person we will use for your group will be the person at the top of this form)
Age
Gender
Housing Codes
Contribution to build big Meditation Hall (optional): $ Total Due: $
Vesak Retreat – Registration form – Updated: 04/06/2012
Fees/ Person/night ($) 55.00 40.00 35.00 30.00 70/Person/ Day 45.00 35.00 30.00 25.00
Amount
Amount Enclosed: $ Which Mindfulness Trainings have you received?
5
14
N/A (please check one)
Please pay in full upon registration. Method of Payment: ___ Cash ___ Check ___ Money Order (please make payment payable to: Unified Buddhist Church (UBC)). Please do not send cash. We also do not accept credit card payment. Please send completed form and contribution to: Magnolia Grove Monastery – Vesak Retreat - 123 Towles Rd. Batesville, MS. 38606 CANCELLAT ION/REFUN D POLICY: Notice of Cancellation On or before April 25th, 2012
Refund Amount Per Person Refund of the amount paid less $50/person processing fee
Notice of Cancellation After April 25th, 2012 After May 01st, 2012
Refund Amount Per Person 50%refund of the full fee 25%refund of the full fee
MEDICATION: Are you or anyone in your family taking certain prescribed drugs that we should be aware of ? Yes No If yes, please specify who and which medication: Name: Which medication: Doctor Contact Information: Doctor Name:
Telephone No.:
LIABILITY WAIVER: The following signatures indicate that participants relieve Magnolia Grove Minfulness Practice Center from all liabilities in the event of any injury or illness incurred while visiting Magnolia Grove Mindfulness Practice Center. Meditation is a complement to, but not a substitution for psychological counseling or medication. Date
/
/
Signed: 1.
In Case of Emergency: Contact name: Date
/
/
/
/
Phone: (
)
Phone: (
)
Signed: 3.
In Case of Emergency: Contact name:
FOR OFFICE USE ONLY
)
Signed: 2.
In Case of Emergency: Contact name: Date
Phone: (
Total Due: $ ___________
Received: ___/___/___ (Signed) _______________________ Confirmation Sent: ____/__/___ □ E-mail □ US Mail _______________
Date___/___/___ Check # __________ Bank ______________________________________ $ ________ Date___/___/___ Cash (Signature) _____________________ Date _____________ $ _______________ Balance Due: $_____________
Vesak Retreat – Registration form – Updated: 04/06/2012