Step 1 - Personal Information » Step 2 - Credit card information » Step 3 - Finish

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Course :
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Personal information
Title :
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Name :
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Lastname :
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Nationality :
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Country of birth :
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Native language :
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Other language :
Date of birth :
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Age :
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Occupation :
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Passport no. :
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Expiry date :
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How is your health? :
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  Give Detail of Illness and/or dietary requirement:  
Contact information
Address :
City :
State / Province :
Zip Code :
Country :
E-mail Address :
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Cell Phone :
Home Phone :
Work Phone:
Fax :
Meditation Experience
1. Have you ever practiced the Dhammakaya Meditation technique before?
2. If yes, how was your recent meditation experience?
3. Have you ever practiced any other meditation techniques before?
4. If yes, what technique did you practice and what was your best experience?
5. Where did you hear about The Middle Way meditation course?
  Brochure from  
  Other (specify)  
4,500 Baht  
I have read and fully understood the Guideline for Joining the Retreat, and I am willing to observe the code of conduct and other requirements expressed therein for the peace and harmony of the meditation community. Required field