Your Name (required)

Your Email (required)

Emergency Contact (required)
(Please provide phone and email and indicate relationship)

Are you a registered student of White Lotus Haven Zen of Connecticut? (required)
YesNo

Please describe your experience with Buddhist teaching/meditation retreats. (required)

Have you professed Precept vows? (required)
(Please describe indicating temple, practice center and teacher)

Vegetarian meals will be prepared. Do you have any special dietary needs? (required)

Do you have any medical or dietary issues? (required)
YesNo

Other Special Needs or Brief Comments: (required)

How did you learn about this WLHZ retreat?
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