[Online] Module 4: Emptiness

...

...

* These fields are required

1 Welcome

2 Pricing

3 People in your group

4 Participant Info

Phone *
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Emergency Contact Name and Phone Number *	Please do not use your own name as an emergency contact
Comments *	Please let us know any special circumstances or needs that have not been covered elsewhere
Would you be interested in serving as a Zoom host? *	Yes, and I have experience! Yes, and I will need training No
May DDL share photos or videos that include you for promotional purposes? (You may withdraw your consent at any time by contacting us.) *	I am happy for photos or videos that include me to be used to share and promote future retreats (e.g., website, social media, print). I prefer not to have my image used for promotional purposes
Can we share your email with other participants and the teacher? *	Yes, I give permission to share my email.
CANCELLATION POLICY *	I have read and accept the Cancellation Policy CLICK THE LINK TO VIEW POLICY
LIABILITY WAIVER *	I have read, understand and accept the Liability WaiverI hereby agree to hold harmless Dorje Denma Ling and Shambhala International, its officers, employees and volunteer staff, from and against any and all claims, liability, loss, cost or obligation, which may arise from participating in programs, employment and activities at Dorje Denma Ling.
CODE OF CONDUCT *	I have read, understand, and accept the Shambhala Code of ConductCLICK THE LINK TO ACCESS FULL CODE DETAILS: If I do not comply with these policies, I understand that I will be asked to leave the land, and that, depending on the offense, I could also be referred to either the independent review board for the Shambhala Code of Conduct or, the police, in the case of a legal offense.
NEWSLETTER SIGN-UP	Please email me the Dorje Denma LIng newsletter.

5 Scholarship & Volunteer (Optional)

6 Donation Options

7 Security Check

8 Payment

	By submitting payment, you authorise Dorje Denma Ling to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Dorje Denma Ling's agreement with you.