Retreat Registration Form – Providence Zen Center

Name*

First Last

Phone*

Email*

Retreat*

Which retreat are you registering for?

Gender*

We'll assign shared rooms by the same gender.

Male
Female
Prefer Not to Answer

What is your age-range?*

Again, this information will help us with room assignments.

What precepts have you taken?*

Please indicate your previous retreat experience, if any:*

Kwan Um School of Zen is abbreviated: KUSZ

Are you currently a due-paying member of the Kwan Um School of Zen?*

Yes
No

Have you sat any 1- or 2-day retreats in the Kwan Um School of Zen?*

Yes. No orientation needed.
Yes but I need a refresher.
No. I'll need an orientation.

When will you be entering the retreat?*

When will you be exiting the retreat?*

Are you a full-time student, senior citizen (over 65) or clergy member?*

Yes
No

If you are registering for an overnight retreat - do you snore?*

Yes
No

Do you have any medical or dietary issues?

Anything else you wish us to know?

Non-Refundable Registration Fee*

Price: $25.00

Click Here to Pay Your Registration Fee
The Providence Zen Center requires a $25.00 registration fee for all retreats. *Don't forget to press the register button on this page after paying the registration fee.* Thank you!

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