Retreat | Yasati

Sign up form for

Intensive Retreat, Long Retreat, Vassa or Year-end Retreat

We advise that you fill the form only if you are really committed and willing to spare time to join.

Please read also instruction, discipline, and daily schedule to better understand the training requirements and make good preparation.

Program

Participant Data

Full name

Email

Place of birth

Date of birth

Gender

Female

Male

Blood type

O

A

B

AB

Phone

Address

City

Zip code

Province

Country

Occupation

Religion

Can speak English

Yes

No

Other…

Vegetarian

Yes

No

Meditation Experience

Have you ever joined the practice of Vipassana Bhavana with Mahasi Sayadaw method? If yes, please state.

How many times

How many times have you joined the practice?

First practice

Date, location, and teacher of first time practice.

Last practice

Date, location, and teacher of last practice.

New Yogi

What meditation technique

What meditation technique have you ever practiced?

Under whose recommendation

Under whose recommentation do you sign up this program?

Old Yogi

What other meditation

What other meditation technique do you practice after the most recent meditation retreat?

Do you practice vipassana

Do you practice Vipassana Bhavana consistently since your most recent retreat?

New and Old Yogi

Physical or mental illness

If you ever suffer physical or mental illness in the past or at present, please mention.

Consume drugs regularly

If you have or are recently consume drugs on a regular basis, please mention.

Consume certain drugs

If you have or are taking certain drugs (hard drugs or drugs/alcohol), please mention the date, frequency, amount, and type.

What is your goal to join

What is your goal to join this Vipassana Meditation practice?

I hereby declare that the information above is true and honest. I have read carefully and understand the existing rules and realized that Vipassana Bhavana is a serious exercise, high discipline, requiring a healthy physic and superfine mental. For that I agree to stay in the compound of this meditation center until the exercise is complete and obey all the imposed rules and disciplines.

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