Vajrayogini Amending Fire Offering

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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*

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4 Participant Info

Have you attended this retreat before-- are you a repeat attendee? *	Yes No
Please register using this link: Vajrayogini Amending Repeater Registration
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
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 your 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 your medical and/or mental issues (held in confidence)
Please list your 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 you may have that have not been covered elsewhere
Can you offer a ride or need a ride? *	Yes No
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
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 ACCES 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 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.
Can we share your email with other participants?	Yes, I give permission to share my email.

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5 Retreat Roles & Info

Will you have completed 1,000,000 Vajrayogini mantras by the start of this retreat? *	Yes No
Thank you for your interest in this retreat! Since there is a strict requirement, we ask that you do not complete your registration.	I understand I do not qualify for this retreat and will not register.You may reach out to us if you feel you qualify for another reason.
Let us know how you can help this program run smoothly. [Check all that apply.]	Chopon Umdze Attend a torma-making party before the program (time & place TBD) Procure some of the supplies (e.g. offering substances, flowers) Flower arranging
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 Volunteers receive room and board during their volunteer days
What dates are you able to help? We will contact you with further details.

6 Scholarship & Volunteer (optional)

Are you applying for a scholarship, discount, or payment plan?	Yes No
Instructions to apply:	1. Submit: Scholarship Application Dorje Denma Ling This will open up a NEW TAB in your browser so you can easily return to this registration form. 2. Once submitting the application, return to this page/tab 3. To complete the process: ~Click Payment ~Choose: Pay Full Amount ~Choose: "Check, E-Transfer, or Scholarships". 4. We will contact you with your new balance.
Are you wanting to volunteer for credit before the retreat?	Yes No
Instructions for volunteering for credit	1. Submit: Volunteer Application for Dorje Denma Ling This will open up a NEW TAB in your browser so you can easily return to this registration form. 2. Once submitting the application, return to this page/tab 3. To complete the process: ~Click Payment ~Choose: Pay Full Amount ~Choose: "Check, E-Transfer, or Scholarships". 4. We will contact you to discuss options.

7 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 your Center

8 Payment

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

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

Due Now	$0 $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, and 2) Send the answer to the security question and the name of the course in an email to finance@dorjedenmaling.com. 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.

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 Lodging & Pricing

Select an option*

Drala Cabin: Single Occupancy

Drala Cabin: Double Occupancy

Gyatso Lodge: Double Occupancy

Wood Cabin: Single Occupancy

Wood Cabin: Retreat

Wood Cabin: Double Occupancy

Bring Your Own Tent: Platform Provided

Bring Your Own Tent, RV, Camper, Car/Van Camping: No Platform

DDL Tent with Platform: Single and Couple's Occupancy

Shrine Room Floor: Garuda & Dragon

Offsite Lodging

3 People in your group

4 Participant Info

5 Retreat Roles & Info

6 Scholarship & Volunteer (optional)

7 Donation Options

8 Payment