Have you attended a meditation retreat before?   

Details of the closest relation or a friend to inform in case of emergency:
Please state His/Her 

a)      Name:

b)     Telephone:

c)      Your relationship with the nominee:

Are you under medication for any physical or mental disease? (if ‘yes’ give a brief description about your illness)

Declaration of Accuracy and Responsibility:

I hereby declare that the personal information provided above is accurate. I am voluntarily joining the meditation program organized by the Buddhist and Pali University of Sri Lanka and acknowledge that neither the meditation teachers nor the organizers of this retreat will be held responsible in case of any unexpected emergency, especially sudden illness.

I understand and agree to abide by the rules, regulations, and conditions stated by the organizers of the retreat and will always comply with them. This agreement is made freely and without any coercion.