|
Prairie Zen Center Sesshin Registration Form
|
|
|
|
|
Name |
|
|
Age
|
|
|
Gender
|
|
|
Address |
|
|
City |
|
|
State
|
|
|
Zip |
|
|
Home Phone
|
|
|
Work Phone
|
|
|
Email
|
|
|
Emergency Contact (Name & Phone)
|
|
|
Sesshin Attending |
|
|
If attending part time, specify days/times
|
|
|
|
|
Newcomer’s orientation is the first day at 6:00 p.m.; check in no later
than 7:00 p.m.Sesshin begins at 7:30 p.m. The cost for full time
attendance is $105 for dues paying members and $150 for non-members for the
3-day sesshin and $175 for members and $250 for non-members for the 5-day
sesshin. The cost for part-time attendance is $35 per day for dues paying
members and $50 per day for non-members. For those on limited income,
a fee of $25 per day is available on request. The payment should be received
by PZC three weeks prior to sesshin. Late registration requires an added $10
per day of attendance. A full refund is available for cancellation up to one week before sesshin.
Your attendance at sesshin is not confirmed until payment is received.
|
If your schedule changes or your arrival is
delayed, please notify PZC by leaving a message
at 217-355-8835 or by sending
an email to
pzc@prairiezen.org
|
|
If you need to rent oryoki (eating bowls) check
here, and add $5 to your fee
|
|
|
|
|
Work Skills (select all you have experience in) |
|
|
|
|
|
|
Other information (ie. physical and other conditions limiting
participation, serious allergies, etc.)
|
|
|
|
By submitting this form, you stipulate the following:
I agree to maintain a daily sitting practice between the time of application and
sesshin and to participate fully in the entire sesshin schedule. I understand that my physical, mental, and emotional well-being are my own responsibility. I understand that Zen
practice is not a substitute for therapy. I am seeking medical care or therapy for existing conditions. I have notified doctors or therapists of my participation and have
ascertained their availability for consultation, if necessary. I am capable of undertaking the rigors of sesshin at this time. I have revealed all pertinent information on this
form. I also agree to sign a waiver releasing the Center, its directors, volunteers, and the owners of 515 S Prospect from any liability resulting from my participation in sesshin.
|
|
|
|
Send payment to:
Prairie Zen Center
515 South Prospect
Champaign, IL 61820
|
|
|
|
|
|