Two Weeks of Meditation: Shamatha-Vipashyana Half-Datun

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GENEROSITY POLICY NOTICE: Donor-supported sliding scale and scholarship options are available. To ask about this or to set up a payment plan, write to finance@dorjedenmaling.com.

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1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

After completing this form, emails will be sent to everyone in your group to complete their information.

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4 Optional Items

5 Participant Info

Phone *
Cell Phone *	Enter cell number or No if you do not have one
Comments or Special Needs	Please let us know any special circumstances or needs you may have.
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
How did you hear about the retreat ? *
Gender *	This info is needed for accommodation purposes. Thanks.
To your knowledge, do you snore? *	Yes No
Requested Roommate
Diet *	Gluten Free, Lactose Free, Enter Other Diet Notes in the Box Below
Food Allergies or Other Diet Notes *	Please note any other specific dietary needs or enter No
Emergency Contact Name and Phone Number *	Please do not use your own name as an emergency contact
Medical Issues *	Please note any medical issues or enter "no". If this information pertains to your child, let us know if they have any learning or behavioural challenges.
Drug or Other Medical Allergies *	Enter No if you have no drug or medical allergies. Food allergies should be entered under the Diet Question.
Medical Drugs *
Do you have any physical difficulties or challenges we should know about? *	This would include injuries from the past, and present conditions. It will help the teacher and meditation instructors support your physical needs.
In order to support you during your stay, please tell us if you have any mental health challenges we should know about. (Held in strictest confidence.) *	Retreat is a powerful practice that can trigger various mental states. It is essential that the teacher and meditation instructors understand your history so that they can support you during the retreat.
Do you use a chair, a cushion, or both in the shrine room? *
Travel Info	If you are traveling from outside of Nova Scotia, let us know how you plan to get here, where you are travelling from and the approximate time you will arrive at Dorje Denma Ling. We may reach out again for this information to aide in your arrival.
ROTA Experience *	Shrine Keeper / Chopon Audio Visual Ikebana Event Coordination Dining Service Coordination Teachers Service Culture & Decorum Health / Medical Training Oryoki Umdze and / or Service Kasung None of the above. Please select all that apply, or none of the above if none apply.
Have you practiced oryoki, the meditative form of eating based on the Japanese Zen tradition?
What is your current meditation or mindfulness practice, if you have one? *	Please indicate if you are new to meditation or what your experience is. There is no requirement to attend the program. Meditation instruction will be offered. This information is helpful for the instructors.
Other Discipline or Practice	Please list any other mindfulness disciplines you currently practice or study.
How long have you been meditating? *
Do you have, or have you had, a regular meditation instructor? *
References: Please provide the name and email of your Meditation Instructor or someone you consider to be a mentor if you don't have an MI. *
Why is it important for you to attend this retreat? How do you hope to benefit from the practice? *	Tell us something about your inspiration to practice and study the dharma.
Which teacher(s) have you studied with?
CANCELLATION POLICY *	I have read and accept the Cancellation PolicyCLICK THE LINK (LABEL TITLE) TO VIEW FULL DETAILS 1. Cancellations Two Weeks or More Before Arrival DAY: will be charged a 10% fee of total program cost ($250 cap, other payments refunded). 2. Cancellations Two Weeks of Arrival Date UP TO the Day Before Arrival will be charged a 20% fee of total program cost ($500 cap, other payments held as program credit). 3. THERE WILL BE NO REFUND OR PROGRAM CREDIT FOR PERSONS WHO CANCEL THE DAY BEFORE OR DAY OF ARRIVAL DAY, OR DO NOT SHOW UP FOR THE PROGRAM, OR LEAVE THE PROGRAM EARLY.
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 ON THE TITLE LABEL TO ACCES FULL CODE DETAILS. As a participant in a Dorje Denma Ling event, I will uphold the Practices of Good Conduct and Protecting the Space for Everyone as well as the tenets of the Four Policies: 1) Policy for Child Protection, 2) Policy on Conduct of People Holding Positions of Authority, 3) Policy to Address Sexual Misconduct and 4) Policy on Diversity, Inclusivity & Anti-Discrimination. If I do not comply with these policies, I understand that I will be asked to leave the land, and that, depending on the offence, 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 offence.
NEWSLETTER SIGN-UP	Please email me the Dorje Denma LIng newsletter.
SHARE PARTICIPANT EMAILS	Yes, I give permission to share my email with other participants in the program. This can make it easier for us to put you in touch with others who may need or be able to share a ride with you. Uncheck if you don't want your email shared.

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7 Payment

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	Your registration, donation or Heart Gift offering will be complete once we receive your payment. If you are using e-transfer: 1) be sure to note the name of the program for which you are paying, and 2) if you are using a security question, then send the answer to the question and the name of the course in an email to finance@dorjedenmaling.com. Otherwise we might not be able to process your payment. If paying by check, please send checks to: Finance Office Dorje Denma Ling 2280 Balmoral Rd, The Falls, Nova Scotia, B0K1V0, Canada Click on the button below and these instructions will be repeated on the next page.

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IMPORTANT INSTRUCTIONS IF YOU ARE USING FIREFOX: When navigating to the credit card number, expiration date, and security code fields... you must tab twice or click twice on the fields in order to activate them and be able to enter your data. We are working to resolve this issue.

1 Welcome

2 Prices listed below are all inclusive: they include accommodation, meals and tuition.

Select an option*

Drala Cabin: Single Occupancy (150/night)

Drala Cabin: Double Occupancy (60/night)

Gyatso Lodge: Single Occupancy (150/night)

Gyatso Lodge: Double Occupancy (60/night)

Large White Tent: Single Occupancy

Large White Tent: Double Occupancy

Wood Cabin: Single Occupancy

Wood Cabin: Double Occupancy

White Hut: Single Occupancy

White Hut: Double Occupancy

Bring Your Own Tent: Platform Provided

Bring Your Own Tent, RV, Camper: No Platform

Shrine Room Floor: Garuda (25/night)

Live or Staying Locally

3 People in your group

4 Optional Items

5 Participant Info

6 Donate

7 Payment