Registration Form Tuesday Drop In Mindfulness Meditation Sessions
Please fill all the sections. This form is only for Tuesday Drop In Meditation Sessions. If you wish to register for a course, please use other form below the course description.
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Terms and Conditions.
Dhamma Nikethanaya Buddhist Academy Every Tuesday Evening Drop In Session with Chanting Meditation and Discussion with Tea Coffee Terms and Conditions.  

Thank you for taking an interest in our Tuesday evening Drop In Session group. The group has been formed to support and encourage the practice of meditation within the context of Buddhism.

Everyone who attends shares in the cultivation of an environment which promotes trust and commitment. We also need to feel safe, so there needs to be adequate precautions to prevent unwanted disturbances. 

There are a number of conditions which we feel help meet these aims and we ask you to read through them. If you are in agreement, please contact the facilitator to confirm and you will be sent an acknowledgement.

Joining the Group:
Anyone wishing to attend the group is required to:
Have attended the Letchworth Buddhist Academy Mindfulness course.
And/or be known to the Head of the Centre, the Secretary or current members of the Sangha.
Anyone unknown to the above will need to meet with the facilitator beforehand.
On approval your name will be added to a participant list and details will be provided to attend the centre.

Personal etiquette:
Each participant accepts equal responsibility to maintain a suitable environment for meditation.
Please arrive promptly.
Please dress properly and appropriately. 
Be wholehearted in the practice please do not multi-task; check emails, move around or eat during the meeting.
The facilitator has the right to remove anyone not adhering to the spirit of the meeting.

Facilitators:
Dr Thura Limbin & Ms Padma Wijeratne  
Head of Centre/Course Lead: Bhante Samitha  Mobile: 07983466105
Charity Secretary: Padma Wijerathna Mobile: 07944 13 53 14
Email: buddhistacademy@gmail.com 
www.buddhistacademy.com
I have read and wish to accept the above terms and conditions *
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What Course you would like to register. This form is only for Tuesday Drop in Sessions. To Register for Courses please use the other forms from the link under the course details.
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Have you done our Beginners Course or Adanved Course or Diploma Course. *
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Full Name with title: Mr/Miss/Mrs or Other *
Date of Birth *
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Email *
Address with Postcode *
Mobile *
Landline
Name of Next of Kin (In Case of Emergency)
Contact Number of Next of Kin (In Case of Emergency)
This Mindfulness Course is based on Equality Policy which anyone can be participated without any prejudices: In respect of that, we should be grateful if you could provide following details:  participated without any prejudices: In respect of that, we should be grateful if you could provide following details: How would you best describe your country of origin or Ethnicity:
Nationality
Faith/Religion/Belief
Profession (Occupation: If this is a self-developed enterprise please describe briefly)
Please give us an indication of your previous meditation experiences
How did you find us or this course (News Paper Advert/Website/Recommended by a Friend or other)
Why did you choose to follow this course and what do (would) you expect from this in life in the future
Special Needs
Health: Please indicate any current physical health difficulties, and/or any mental health issues, either present or past
Course Contribution: Donation. I wish to enclose a cheque/Cash for £...... as a contribution towards the cost of this drop in session. Or please note here how you wish to contribute.   If anyone wishes to participate in any other form, there will be further opportunities for dana/donations towards our community meditation. Cheques: "Letchworth Dhamma Nikethanaya Buddhist Centre" Course Contribution: Donation. If you like to make online, please use the following bank details to pay the course fee:     Sort Code: 20-41-15     Account: 93992683      Barclays Bank PLC, Letchworth     A/C Name: Letchworth Dhamma Nikethanaya    Kindly set "your name" as online bank reference.   All the details are on our website. www.buddhistacademy.com 
Further Support One wishes to offer to Our Centre: If anyone wishes to participate in any other form, there will be further opportunities for dana/donations towards our community meditation. Cheques: "Letchworth Dhamma Nikethanaya Buddhist Centre"
14. Gift Aid your donation: Declaration: Letchworth Dhamma Nikethanaya International Centre For Education, Meditation, Psychotherapy and Counselling (LDN) is a registered Charity. If you are a UK taxpayer, completing this declaration by ticking the box, will increase your donations by 25% at no cost to you. Please say YES or NO to the following statement. "I am a UK taxpayer and would like the Letchworth Dhamma Nikethanaya to treat all donations I make on or after 6th April 2000 as Gift Aid donations, and that the Letchworth Dhamma Nikethanaya can claim gift aid on my behalf. "
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Data-Protection: Your information will be treat as confidential to improve our better understanding about you. We would like to retain your information, if you do not wish us to do so, please indicate accordingly:  Yes/No
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For More Information, please contact: Mobile: 07983 466 105 or 07944 13 53 14  Email: buddhistacademy@gmail.com
I wish to register to the Tuesday Drop In Sessions. Please write / sign your name and put the date. Thank you for your time. You will receive an email with login details if you have accepted to this group.
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