REGISTRATION FORM FOR MEDITATION RETREAT / pndform1.htm

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REGISTRATION FORM FOR MEDITATION RETREAT Panditarama Shwe Taung Gon Sasana Yeiktha 80-A, Than Lwin Road, Shwe-gon-dine P.O. Bahan, Yangon, Myanmar(Burma) Tel: (951) 531 448, Fax: (951) 527 171	PHOTO
1. FULL NAME (In Block Letter):
2. SEX:	3. DATE OF BIRTH:
4. NATIONALITY:	5. RACE:
6. PASSPORT NO:	7. OCCUPATION:
8. RELIGION:	9. MARITAL STATUS:
10. HOBBIES:
11. PERMANENT ADDRESS: TELEPHONE NO:
12. NAME, ADDRESS & TELEPHONE NO. OF CLOSE RELATIVES OR FRIENDS TO BE CONTACTED IN CASE OF EMERGENCY:
13. INTENDED PERIOD OF STAY:
14. THE PURPOSE OF UNDERTAKING THIS MEDITATION COURSE:
15. ANY PREVIOUS MEDITATION EXPERIENCE: (IF YES) - TEACHER, TYPE OF MEDITATION PRACTISED, FOR HOW LONG AND WHERE:
16. HOW DID YOU HEAR OF THIS CENTRE:
17. STATE ANY HISTORY OF MENTAL OR PSYCOLOGICAL ABNORMALITY:
18. STATE ANY HISTORY OF PREVIOUS PHYSICAL DISBILITY OR ILLNESS: