Templestay Application

Please make sure to fill out all the necessary fields COMPLETELY so that the application can be processed promptly.

1. Personal Details

Surname *This question is required.

Given Name *This question is required.

Buddhist Name

Date of Birth (MM/DD/YYYY) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Marital Status *This question is required.

Gender *This question is required.

Street Address 1 *This question is required.

Street Address 2

City *This question is required.

State

Zip

Country *This question is required.

Email Address *This question is required. This question requires a valid email address.

Mobile Phone

Phone Number

Fax

Occupation *This question is required.

Place of Birth *This question is required.

Country of Passport (if applicable)

2. Program Details

Program Start Date (MM/DD/YYYY) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Program End Date (MM/DD/YYYY) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Number of days This question requires a valid number format.

3. Health

Do you have any health related issues, mental illness or food allergies? *This question is required.

Please describe any health issues and and list any long-term medication you are using. *This question is required.

4. Language

The retreat program is led in English. Do you need translation?

Please list any other preferred language(s):

5. EMERGENCY CONTACT

Given Name *This question is required.

Surname *This question is required.

Relationship *This question is required.

Tel (Including country code) *This question is required.

Email This question requires a valid email address.

Address *This question is required.

City *This question is required.

Country *This question is required.

6. Kwan Um School of Zen Membership

Are you a current member of a KUSZ center? *This question is required.

Name of Zen Center or Temple *This question is required.

Name of Guiding Teacher *This question is required.

What interests you most about joining Templestay? *This question is required.

7. Declaration *This question is required.

By ticking the checkbox I certify that all of the above statements are true and complete to the best of my knowledge *This question is required.

Agree

Date This question requires a valid date format of MM/DD/YYYY.

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From time to time, we take group photos during programs at Musangsa. Do you give Musangsa permission to have your photograph taken while participating in Musangsa's programs? If you are in a group photo, it will be used solely for the purpose of publicity for promoting activities at Musangsa. The photo will not be shared with any third party. *This question is required.

Do you give Musangsa permission to store your email address in order to send you notifications of future programs? Your email address will not be distributed to any third party.

Please submit a recent photo of yourself separately by email to office@musangsa.org with your name and dates for your Templestay participation.

Important: This application will be received and approved by the Guiding Teacher before the applicant is admitted to any retreat program. The same applies to former retreat participants.

MUSANGSA T: +82 42 841 6084 F: +82 42 841 1202 office@musangsa.org www.musangsa.org