Registration Form

Please note:

The form contains several sections (click on each section name to open) and
all fields marked with a red asterisk must be filled before the form can be processed.

If the form is filled in correctly, when you "submit" you will get a screen that says "Thank you" at the top; you will soon receive an e-mail with a copy of the data from your form; and within 3 days you will receive an e-mail from the Birken office confirming your visit. If any of these does not happen, you are not registered.

If the form is NOT filled in correctly, you will get a screen with red at the top, indicating which fields need to be filled in. Please continue until you get the "Thank you" screen, or we will not get your registration form.

Contact information

First and Last Name: *

Address: *

Full mailing address with postal code

Phone: *

Email: *

Emergency contact: *

Name, e-mail address, phone number of person to contact in an emergency, or if you do not arrive as scheduled. This should not be someone you are travelling with.

Registering for a Retreat at Birken Forest Monastery

Type of visit: *

Personal Retreat

Winter retreat March 2012

Even if you select a formal retreat, you must fill in the arrival & departure dates. You are welcome to come before the retreat, and/or to stay on after.

*Note: Before deciding on a date for your registration submission you should check our current list of room vacancies.

Requested arrival date: *

Requested departure date: *

Traveling to Birken

Expected arrival time: *

How + with whom: *

Let us know your mode of transportation (car, bus, plane, etc), with flight number, arrival & departure times, as appropriate.
Indicate if you are travelling with someone else, or if you are part of a group.

Expected departure time: *

If traveling by car, are you able to offer a ride to other retreatants:

Yes

Please enter your offer or request for a ride on our Rideshare Board.

Do you need a ride from Kamloops: *

Yes

Available only on Wednesday afternoons. Otherwise, see the "Rides" page for information on booking a taxi. You can also enter a ride request on our Rideshare Board.

To place you in appropriate accommodations

Gender: *

Female

Male

Age: *

Do you snore: *

Yes

Don't know

Room request: *

Main guest house

Cabin (Kuti)

Doesn't matter

Where would you prefer to stay? Kutis are rarely available, and we make no promises, but we do try to accommodate expressed preferences.

Helpful information

Have you been to Birken before: *

Yes

If YES: What type of retreat(s) have you attended? :

If applying for a retreat, you must let us know what kind of retreats you have done here before. (personal/weekend /5 or 10-day, etc.) List all that apply.

Have you been on retreats elsewhere: *

Yes

If YES, brief details:

If you are applying for a retreat, we need to know if you have attended residential, silent retreats elsewhere, how long, and how many. E.G. "four 10-day Goenka retreats in noble silence"

Have you practised meditation before: *

Yes

If YES, brief details:

Please tell us how long you have been practicing; and what is your current practice. For example: "Meditating for 10 years; sit twice daily for 30 minutes each" or "Just started this year; I try to sit 20 minutes a day."

Special Needs

Do you have any serious medical condition?: *

Yes

Please tell us about any conditions that might affect your participation in the monastery schedule, activities, guidelines, precepts.

If YES, give brief details:

We need to know if your condition is controlled by medication, stable or unstable, likely to cause you a problem while you are here, and if you need special support during your visit.

Do you suffer from any kind of mental illness?: *

Yes

Please tell us about any conditions that might affect your participation in the monastery schedule, activities, guidelines, precepts.

If YES, brief details:

We need to know if your condition is controlled by medication, stable or unstable, likely to cause you a problem while you are here, and if you need special support during your visit.

Have you had any recent problems with drugs or alcohol: *

Yes

If YES, brief details:

Are you taking any prescription medication: *

Yes

If YES, brief details:

Monastery Guidelines

I have read the Birken Etiquette Guidelines: *

Yes

(Our etiquette guidelines can be found at http://birken.ca/visiting/guidelines/etiquette.)

I agree to abide by the following Precepts while I am a guest at the Monastery: *

Eight Precepts

Seven Precepts: have medical need for food after noon identified below

Request for another exception explained below

I do not agree to abide by the Precepts

(The Eight Precepts can be found at http://birken.ca/visiting/guidelines.)

Request for exception from 8 Precepts:

You must request any exception to the precepts for each visit, including:
If you have medically diagnosed hypoglycemia or diabetes, or if you need to take food with your medications, you may bring the special foods you need. Nothing that requires cooking or refrigeration, please. To be kept in our cool room, not in your bedroom.

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Sītavana

Registration Form

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