The House of Dhamma

Workshop application form

Date of workshop

Mr/Mrs/Miss Name
Surname

Permanent address

tel
email address

Temporary address in Thailand

tel.

Date of birth
nationality

Passport or ID number
Occupation

Name and address of a person to contact in emergency

Note: Please see the details on the website for a guide to donations.

I agree to abide by the rules of the meditation retreat/workshop.

Yes No

Please return by e-mail at least 7 days before the first day of the workshop.