Dropping into the Awareness Zone

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1 Welcome

4 Participant Info

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Phone *
Emergency Contact Name and Phone Number *	Please do not use your own name as an emergency contact
What is your age? *
Gender *	This info is needed for accommodation purposes. Thanks.
Requested Roommate
To your knowledge, do you snore?	Yes No
Diet *	Gluten Free, Lactose Free, Enter Other Diet Notes in the box below
Do you have any food sensitivites or allergies? *	yes no
Please list any food allergies or sensitivities or any notes about diet we should know
Are you on any medications, have any drug allergies or medical/mental issues that we need to know in the event of an emergency? *	Yes No
List medical and/or mental issues (held in confidence)
Please list prescriptions and/or drug allergies (held in confidence)
Do you have any physical difficulties we should know about? *	Yes No
Please list these, including injuries from the past and present conditions. It will help the teacher and meditation instructors support your physical needs.
Comments	Please let us know any special circumstances or needs that have not been covered elsewhere
Can you offer a ride or need a ride? *	I need a ride OR can offer a ride No If registering for a group, choose the best option for the group
Arrival Air Flight #, Airline, Date and Time of Arrival	If you need a ride, please fill this out. If you don't know the details now, you can adjust your answers once you do.
If you Need a Ride from another place than the airport, please fill in your pickup location, day, and preferred time.
For those able to Give a Ride, please enter your travel date, where you are travelling from, and a preferred time for pickup
Will you need a parking space? Please only check one.	Yes No Yes, and I will need a handicapped parking spot I don't know I am a passenger in a car Yes, and I will be camping in my vehicle If you are registering for a group, choose the option that the group will need
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.
Can we share your email with other participants and the teacher?	Yes, I give permission to share my email.

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5 Retreat Roles & Info

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
Preference: Chair or Cushion? *	We will have extras of each, please pick your primary setup. We have minimal support cushions that are saved for those flying in. If you are able, please bring anything extra you will need to enhance your comfort during the retreat.
Are you interested in coordinating or staffing this program?	If you are interested, please list your experience and area of interest. Ex: overall coordinator, shrine room coordinator, chopon, etc.
Would you like to come early or stay later to help with setup/breakdown of the retreat?	Yes I can either come early or stay later No
What dates are you able to help? We will contact you with further details.
Do you have medical training and are willing to help if needed?
Do you have experience as an umdze/timekeeper for Anam Thubten Rinpoche and would like to be a part of the team?	Yes, I do have experience as an umdze/timekeeper for Anam Thubten Rinpoche I don't have experience, but I am interested in learning No
Do you have experience or interest in these areas and would like to help? *	Flower arranging Shrine keeping Flag raising Water service Kasung service Gatekeeping No experience/interest in these areas
Everyone will participate in rota to support our retreat. Please check the boxes that you have experience with. *	Food Prep Dishes Housekeeping Gardening Child care for family programs I am physically unable to do rota
This retreat has four sessions a day, starting at 6:30 am and ending at 9 pm. Do you have any physical or mental limitations that may keep you from fully participating? *	I am able to commit to participating fully in this retreat I may not be able to participate fully, and will create a retreat intention No one will be turned away. While Rinpoche encourages us to commit to the entire retreat, he understands this may not be possible. Knowing intentions prior to the retreat will help form a container that is helpful personally and overall.
Anam Thubten Rinpoche is offering Refuge and Bodhisattva vows at the Fellowship Ceremony following lunch on departure day. Choose the option that best describes your plan. *	I would like to formally take vows I would like to be a witness at the ceremony I will not be attending the Fellowship Ceremony If you change your mind during the retreat, please let the retreat coordinator know of your intention.

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6 Discount, Scholarship & Volunteer (optional)

Are you 30 or under?	Yes No By Selecting Yes, you confirm that you are 30 or under at the start of the program.
Input the code 30ANDUNDER at checkout and receive a 25% discount on program fee and meals.
Are you a monastic?	Yes No
Input the code MONASTIC at checkout to receive an 80% discount on program fee and meals.
Will you be applying for a scholarship?	Yes No Clicking yes does not qualify as applying. Follow the instructions below to complete the process.
Instructions to apply:	SCHOLARSHIP REQUEST LINK Fill out a Scholarship Request at least one month prior to the event. To complete your registration, choose "Check, E-Transfer, or Scholarships" for your payment option. We will contact you.
Are you wanting to volunteer before or after this retreat?	Yes No
Instructions for volunteering for credit	Please complete your registration and choose "Check, E-Transfer, or Scholarships" for your payment option. Once complete, fill out a Volunteer Application. Credit must be earned prior to the retreat. We will contact you.

7 Questions from Anam Thubten Rinpoche

Is this your first residential retreat with Anam Thubten Rinpoche? *	Yes No
How long have you had a meditation practice? *

8 Donation Options

CAD $	Donation for Dorje Denma Ling Thank you for supporting your practice center!
CAD $	Donation to our Scholarship Fund Your generosity will help participants attend a retreat they may not be able to otherwise.
CAD $	Help Support Solar Sustainability at Dorje Denma Ling

9 Security Check

Security check

10 Payment

Discount Code

Option to pay credit card fees	I would like to help offset the fee for using my credit card. Dorje Denma Ling is charged when participants use credit cards. Help us become sustainable!
3% Option to pay credit card fees	$0

Sub Total	$0

Donations	$0

Taxes	$0

30% Deposit	$0
	$0 next payment date * last payment amount will be $0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Remaining Balance	$0

Choose Payment Option

	SCHOLARSHIP APPLICANTS: CLICK REGISTER to complete the application/registration process. We will process your application and contact you with the new balance. TO PAY USING E-TRANSFER: 1) be sure to note the name of the program for which you are paying 2) send your e-transfer to finance@dorjedenmaling.org TO PAY BY CHECK: Finance Office Dorje Denma Ling 2280 Balmoral Rd, The Falls, Nova Scotia, B0K1V0, Canada Your registration or donation will be complete once we receive your payment. Click on the button below and these instructions will be repeated on the next page.

	You will be asked for payment details in the next step. Click the button below to continue.

	By submitting payment, you authorize 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.

Guest 1		First Name* Last Name* Email* Phone* Emergency Contact Name and Phone Number* Please do not use your own name as an emergency contact What is your age?* Gender* This info is needed for accommodation purposes. Thanks. Diet* Gluten Free, Lactose Free, Enter Other Diet Notes in the box below Do you have any food sensitivites or allergies?* yes no Are you on any medications, have any drug allergies or medical/mental issues that we need to know in the event of an emergency?* Yes No Do you have any physical difficulties we should know about?* Yes No 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. Do you have experience or interest in these areas and would like to help?* Flower arranging Shrine keeping Flag raising Water service Kasung service Gatekeeping No experience/interest in these areas Everyone will participate in rota to support our retreat. Please check the boxes that you have experience with.* Food Prep Dishes Housekeeping Gardening Child care for family programs I am physically unable to do rota
Guest 1		First Name* Last Name* Email* Phone* Emergency Contact Name and Phone Number* Please do not use your own name as an emergency contact What is your age?* Gender* This info is needed for accommodation purposes. Thanks. Diet* Gluten Free, Lactose Free, Enter Other Diet Notes in the box below Do you have any food sensitivites or allergies?* yes no Are you on any medications, have any drug allergies or medical/mental issues that we need to know in the event of an emergency?* Yes No Do you have any physical difficulties we should know about?* Yes No 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. Do you have experience or interest in these areas and would like to help?* Flower arranging Shrine keeping Flag raising Water service Kasung service Gatekeeping No experience/interest in these areas Everyone will participate in rota to support our retreat. Please check the boxes that you have experience with.* Food Prep Dishes Housekeeping Gardening Child care for family programs I am physically unable to do rota

1 Welcome

2 Lodging & Pricing

Select an option*

Gyatso Lodge: Double Occupancy

Drala Cabin: Double Occupancy

Wood Cabin: Retreat Triple Occupancy

Wood Cabin Triple Occupancy

Large White Tent: Double Occupancy

White Hut: Double Occupancy

Bring Your Own Tent: Platform Provided

Bring your own tent, No platform

RV, Camper, Car/Van Camping without a platform

Shrine Room Floor: Garuda & Pavilion

Offsite Lodging

3 People in your group

4 Participant Info

5 Retreat Roles & Info

6 Discount, Scholarship & Volunteer (optional)

7 Questions from Anam Thubten Rinpoche

8 Donation Options

9 Security Check

10 Payment