GENERAL RETREAT

How to Register You may register for the retreat by email or mail. Please email the registration form to office@magnoliagrovemonastery.org or mail it to our mailing address. How to fill out the registration form: If you would like to share a room with a specific person, please register on the same form. If you do not specify a roommate, we will assign roommates by gender. For each person in your group or family, print the full name on the form. Please use an extra sheet as needed. We will be sending the confirmation information to the person and address filled out at the top of the registration form. Register by email to: office@magnoliagrovemonastery.org Register by mail to: Magnolia Grove MPC, 123 Towles Rd., Batesville, MS. 38606 Payment by check or money order, payable to Unified Buddhist Church (UBC). Confirmation: You will receive a confirmation packet in about one week after we have received and processed your registration. Included in the packet will be information about retreat activities and how to enjoy them, as well as other pertinent information. Housing Information: Due to the limited housing at Magnolia Grove MPC, you can only choose dormitory (limited couple/double room) or camping in the premises of the Monastery. All rooms are 5-10 beds (bunk beds) with public bathrooms. Transportation: Airport: Memphis International Airport (MEM), 56 miles from Magnolia Grove MPC. Shuttle service from Memphis International Airport to Magnolia Grove MPC: Please contact Jefferson Travel at (901) 3614246 to make your own reservation. Please call at least three days in advance.

Public transportation: There is no public transportation available to Batesville, MS.

For further questions: Please contact us by email at office@magnoliagrovemonastery.org, or by phone at (662) 563-0956. Due to the schedule of the community activities, there will be times when we are unable to answer your phone calls. However, please do leave us a message and we will call you back as soon as we can. Any questions that you might have about the retreat and retreat housing should go to us at the email and number above or leave a message on the answering machine and we will call you back as soon as we can. We look forward to an opportunity to practice together with you.

General Retreat Registration form Updated: 03/10/2012

FILE NO.

Address: 123 Towles Rd. Batesville, MS. 38606 Tel.: (662) 563-0956 Website: http://www.magnoliagrovemonastery.org Email: office@magnoliagrovemonastery.org

GENERAL RETREAT Registration Form

Please print the requested information below clearly
Name (Last, First ): Address: City: Daytime phone: Arrival date (Friday only): ___________ Time: _______ -Rates: Fees include tuition, accommodations, meals -Housing Information: Due to the limited housing at Magnolia Grove MPC, you can only choose dormitory or camping. All rooms are 510 beds (bunk beds) (a few couple/double rooms available) with public bathrooms. Contributions to build the Meditation Hall: Your generosity makes it possible for the monastery to build a big meditation hall. Any amount would be appreciated. Donations are tax deductible. -People with physical disabilities and/or special needs: Please contact us at (662) 5630956 before registering so we can see how we may support you. Last name, First name (the contact person we will use for your group will be the person at the top of this form) State: Zip: Evening phone: Departure date: ______________ Time: _______ Accommodation Type (if you do not specify a roommate on this form we will assign you roommates by gender) ADULT STUDENT (ages 18-26) TEEN (ages 13-17) CHILD (ages 6-12) ADULT STUDENT TEEN CHILD 2 separate beds with public bathroom Fees/ Person/night ($) Country: Email:

Housing Codes

DORM-A DORM-S DORM-T DORM-C CAMP PLEASE BRING YOUR OWN TENT

45.00 35.00 30.00 25.00 40.00 30.00 25.00 20.00 60/Person/day

COUPLE

Age

Gender

Housing Codes

Amount

Contribution to help build big Meditation Hall (optional): $ Total Due: $ Amount Enclosed: $

General Retreat Registration form Updated: 03/10/2012

Which Mindfulness Trainings have you received?

5 14 N/A (please check one)

Please pay in full upon registration. Method of Payment: ___ Cash ___ Check ___ Money Order (please make payment payable to: Unified Buddhist Church (UBC)). Please do not send cash. We also do not accept credit card payment. Please send completed form and contribution to: Magnolia Grove MPC General Retreat - 123 Towles Rd. Batesville, MS. 38606 or Email to office@magnoliagrovemonastery.org CANCELLATION/REFUND POLICY: Notice of Cancellation On or before 21 days of your arrival Refund Amount Per Person Refund of the amount paid less $25/person processing fee Notice of Cancellation Before 14 days of your arrival Before 5 days of your arrival Refund Amount Per Person 50% refund of the full fee 25% refund of the full fee

MEDICATION: Are you or anyone in your family taking certain prescribed drugs that we should be aware of? Yes No If yes, please specify who and which medication: Name: Which medication: Doctor Contact Information: Doctor Name: Telephone No.:

LIABILITY WAIVER: The following signatures indicate that participants relieve Magnolia Grove MPC from all liabilities in the event of any injury or illness incurred while visiting Magnolia Grove MPC. Meditation is a complement to, but not a substitution for psychological counseling or medication. Date / / Signed: 1. Phone: ( )

In Case of Emergency: Contact name:

Date

Signed: 2. Phone: ( )

In Case of Emergency: Contact name:

Date

Signed: 3. Phone: ( )

In Case of Emergency: Contact name:

FOR OFFICE USE ONLY

Total Due: $ ___________

Received: ___/___/___ (Signed) _______________________ Confirmation Sent: ____/__/___ E-mail US Mail _______________

Date___/___/___ Check # __________ Bank ______________________________________ $ ________ Date___/___/___ Cash (Signature) _____________________ Date _____________ $ _______________
Balance Due: $_____________

General Retreat Registration form Updated: 03/10/2012